PubMed · 246595
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G Nygaard Rise. 1978-02-20. [Aphasia].. https://pubmed.ncbi.nlm.nih.gov/246595/
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OBJECTIVE: Delayed cerebral vasospasm is an under-recognized complication of meningitis. This case report is important because it is the first to definitively associate vasospasm with meningitis using catheter angiography. Furthermore, it is the first to correlate the time course of delayed cerebral vasospasm with meningitis. CLINICAL PRESENTATION: We present a patient who developed a partial expressive aphasia 9 days after developing meningitis, consistent with cerebral vasospasm, after lumbosacral spinal surgery. INTERVENTION: Vasospasm was confirmed by angiography and transcranial Doppler sonography, and symptoms responded to hypervolemia, hypertension, and hemodilution therapy. CONCLUSION: If a patient develops neurological symptoms consistent with a timeline of delayed cerebral vasospasm in the setting of meningitis, angiographic evaluation and appropriate therapy should be pursued.
Fifteen years ago, Pascual-Leone and colleagues used transcranial magnetic stimulation (TMS) to investigate speech production in pre-surgical epilepsy patients and in doing so, introduced a novel tool into language research. TMS can be used to non-invasively stimulate a specific cortical region and transiently disrupt information processing. These 'virtual lesion' studies offer not only the ability to explore causal relations between brain regions and language functions absent in functional neuroimaging, but also spatial and temporal precision not typically available in patient studies. For instance, TMS has been used to demonstrate functionally distinct sub-regions of the left inferior frontal gyrus; to clarify the relationship between pre-morbid language organization and susceptibility to unilateral lesions and to investigate the contribution of both left and right hemisphere language areas in recovery from aphasia. When TMS is used as a measure of functional connectivity, it demonstrates a close link between action words and motor programmes; it suggests a potential evolutionary link between hand gestures and language and it suggests a role in speech perception for the motor system underlying speech production. In combination with functional neuroimaging, it can elucidate the circuits responsible for this involvement. Finally, TMS may even be useful for enhancing recovery in aphasic patients. In other words, TMS has already become an important tool for studying language at both the cognitive and neural levels, and it is clear that further developments in TMS methodology are likely to result in even greater opportunities for language research.
BACKGROUND AND PURPOSE: This article is a comprehensive review of aphasia treatment studies for the purpose of investigating the relationship between time postonset of aphasia and response to treatment for aphasia in chronic patients at >/=1 year after symptom onset. METHODS: Studies that demonstrated treatment response (defined as a measurable change in task performance compared with a control task performance) through the use of single-subject design methodologies on measures of verbal output or auditory comprehension were selected. Individual subject data were extracted from the 23 studies that met criteria identifying the subjects as those who received direct continuous therapy for spoken language deficits and whose changes in response to therapy were measurable. Percent of maximum possible change was used as a measurement of outcome. RESULTS: Nonparametric correlation statistics (Spearman rho) and comparisons of group means (Kruskal-Wallis) were used to compare the relationship between time postonset and improvement. Time postonset at which treatment was initiated did not correlate with response to treatment. No significant differences in response to treatment were found between groups of patients according to times postonset. CONCLUSIONS: Time postonset is not related to response to treatment for aphasia in patients >1 year postonset of aphasia.