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PubMed2003

A case of gliosarcoma appearing as ischaemic stroke.

OBJECTIVES: Ischaemic stroke attributable to malignant brain tumour is a rarely reported phenomenon and even various imaging techniques including angiography do not necessarily lead to an accurate diagnosis. CASE DESCRIPTION: A 46-year-old, previously healthy man developed apoplectic symptoms with slight right sided hemiparesis and global aphasia. The computed tomography (CT) scan showed lesions of the left temporal lobe and the paraventricular white matter suggestive of left middle cerebral artery (MCA) infarction. Carotid angiography demonstrated compression of the M1 segment of the MCA and occlusion of temporal MCA. The patient initially refused magnetic resonance imaging (MRI) because of claustrophobia. Because of fluctuating symptoms and successive worsening of the condition over weeks an MRI scan was conducted under general anaesthesia. Beneath temporal, opercular, and subcortical infarctions it revealed a left temporal tumour. A tumour biopsy disclosed a gliosarcoma (WHO grade IV). Microscopical examination of the surgical specimen demonstrated invasion of tumour cells into the wall of a greater pre-existing blood vessel. CONCLUSIONS: Malignant brain tumours may cause ischaemic infarction. This is a rare but important differential diagnosis for the origin of strokes. The authors describe the first case with infiltration of intracranial blood vessels by tumour cells of a gliosarcoma.

Brain Ischemia↗
PubMed1991

The relationship between oral spelling and phonological breakdown in a conduction aphasic.

Unsolicited oral spelling has been observed in conduction aphasics during word-production difficulty (Kohn, 1985), but has never been examined systematically. In the present study, the possible role of oral spelling in the word-production process of a conduction aphasic (JM) is explored. Oral spelling occurred much more frequently during picture naming than during either oral reading or repetition, and it seemed to be operating as a strategy to lessen the phonemic output deficit often observed in this syndrome.

Aphasia, Broca↗
PubMed2006

Clinicopathologic analysis of frontotemporal and corticobasal degenerations and PSP.

OBJECTIVE: To examine the relationship between early clinical features, pathologies, and biochemistry of the frontotemporal lobar degenerations (FTLDs), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). METHODS: The authors conducted pathologic reexamination with the most recent immunohistochemistry of all cases diagnosed with FTLD, PSP, and CBD between 1970 and 2004. The authors also reviewed the early clinical features for clinical diagnosis and application of published research criteria. RESULTS: Of 127 cases analyzed, 57 had a pathologic diagnosis of FTLD, 49 PSP, and 21 CBD. Of these, 38 were clinically reclassified as frontal variant frontotemporal dementia (FTD), 13 as progressive non-fluent aphasia (PNFA), 21 as CBD-like, 33 as PSP-like, and 13 with frontotemporal dementia with coexisting motor neuron disease (FTD-MND). The authors were unable to classify nine cases. All cases of FTD-MND were tau-negative and had pathologic evidence of motor neuron degeneration. All cases classified as PSP-like or CBD-like had tau-positive pathology. Of the 13 cases with PNFA, PSP and CBD accounted for almost 70% of the cases, while FTD was almost equally divided between tau-positive and tau-negative diseases. CONCLUSION: Frontotemporal lobar degeneration, corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP) have overlapping clinical features. The prediction of tau-positive pathology from a CBD or PSP-like presentation is good, while the frontotemporal dementia (FTD)-motor neuron disease syndrome almost certainly predicts motor neuron degeneration. Surprisingly, PSP and CBD accounted for most cases classified as progressive non-fluent aphasia. Frontal variant FTD is an unpredictable disease in terms of its biochemistry.

Aged↗
PubMedDate not supplied

[Cerebral ischaemia secondary to non-bacterial thrombotic endocarditis as the presenting symptom of an ovarian tumour].

INTRODUCTION: In cancer patients, cerebrovascular accidents (CVA) are the most common complication occurring in the central nervous system after metastasis. One of its causations is non-bacterial thrombotic endocarditis (NBTE), which appears on rare occasions as the first symptom of the tumour. The clinical manifestations of NBTE are the result of multiple systemic embolism. Emboli consist of platelets and strands of fibrin that are deposited in the valves of the heart, within a context of a state of hypercoagulability secondary to the tumour. The tumours that are most frequently associated to NBTE are mucin-secreting adenocarcinomas. Cases of ovarian cancer with NBTE are rare in the different series reported in the literature. CASE REPORT: We describe the case of a 58-year-old female, previously asymptomatic, who suddenly showed a lowered level of consciousness, hemiplegia on the right-hand side and motor aphasia. A computerised axial tomography scan taken at 48 hours showed two acute ischaemic lesions in the left hemisphere. Magnetic resonance imaging of the brain with diffusion sequences revealed multiple ischaemic lesions in different arterial territories. Transthoracic echocardiography at 24 hours showed a vegetation on the posterior leaflet of the mitral valve. The patient was treated with intravenous sodium heparin and no new CVA appeared. The valve injuries disappeared after treatment. In a study conducted to search for occult neoplasia, a tumour was found in the right ovary. CONCLUSIONS: NBTE must be taken into account in cases of cerebral embolism due to unknown causes. The results of the analyses of most patients reveal chronic disseminated intravascular coagulation. The most valuable diagnostic tests are the transesophageal echocardiogram and magnetic resonance imaging of the brain with diffusion sequences. Preferred treatment is with heparin.

Brain Ischemia↗
PubMedDate not supplied

[Alterations in the imitation of gestures (conduction apraxia)].

INTRODUCTION AND AIMS: The aim of this presentation is to report the performance pattern of a patient who suffered ideomotor apraxia with a disorder pattern of the conduction apraxia (CA) type. This clinical picture was originally reported by Ochipa et al. in 1994 as an alteration in the pathway that joins the two lexicons; later, in 2000, Cubelli et al. claimed that there is no evidence for the existence of such a pathway and suggested that the symptoms were due to an alteration affecting the mechanisms governing visuomotor conversion. CASE REPORT: A 51 year old patient who, following a traumatic head injury, presented aphasia and apraxia with 40% errors in the imitation of familiar gestures test, 50% errors in the imitation of non familiar gestures (NFG), 0% errors in the visual admission of objects test and 0% in the tool usage test. The differences between the performance in the imitation tests and in the other tests are statistically significant. Although the patient displayed slight alterations in the gesture decision test (20% mistakes), alterations to the action input lexicon would not account for the patient's performance since there is a significant difference between his performance in the imitation of NFG test and the gesture decision test. Moreover, he did not present alterations in the discrimination of gestures. CONCLUSIONS: From the above, it can be said that the patient seems to present CA due to alterations in the non semantic interlexical pathway and in the perilexical pathway, as originally postulated by Ochipa et al.

Aphasia↗
PubMed1998

The boston corpus of aphasic naming errors.

This report provides verbatim error responses to picture naming given by 30 aphasic patients (10 Broca's aphasics, 6 Wernicke's aphasics, 7 conduction aphasics, and 7 anomic aphasics). The error corpus is intended to supply a rich set of raw data for investigators interested in the characteristics of aphasic word-finding problems as well as those interested in general models of lexical retrieval.

Adult↗
PubMed1979

Gunshot injury to the temporal bone: an analysis of thirty-five cases.

By retrospective analysis of 35 surviving gunshot injuries to the temporal bone and by presentation of 6 representative cases, the management and reconstructive procedures of these injuries in the Tulane University affiliated hospitals are presented. The most frequent single injury was facial nerve paralysis (16 cases), followed by external canal injury and conductive hearing loss. Anacusis occurred in 12 cases. In conductive hearing loss the intact posterior wall tympanoplasty with mastoidectomy (16 cases), or the modified radical mastoidectomy (5 cases), allowed middle ear reconstruction. Transmastoid facial canal decompression, combined with the above procedures or with a middle fossa craniotomy, was performed in 6 cases. Delayed facial reconstruction (5 cases) utilized microneural anastomosis between facial-facial and hypoglossal-facial nerves and fascia lata slings. Intracranial complications of thrombosis of internal carotid artery, dural venous lacerations, temporal lobe aphasia, bitemporal hemianopsia, cerebral abscesses and meningitis are also discussed.

Adolescent↗
PubMedDate not supplied

[Therapeutic trials in Alzheimer disease. Selection--recruitment and stratification].

Therapeutic trials conducted in Alzheimer's disease have benefited from the standardization of diagnostic criteria based on internationally recognized scales (DSM III-R, NINCDS-ADRDA) which ensure more valid inclusions. Well specified exclusion criteria are also of the utmost importance, in particular depression, vascular dementia and concomitant psychotropic drugs. Cognitive and/or functional scales allow an appreciation of the severity of the disease. Due to the heterogeneity of Alzheimer's disease stratification methods on identified prognostic factors i.e. aphasia, extrapyramidal symptoms should be performed. Selection of responders during an enrichment phase has still to be discussed. Multicentric studies become imperative because of the large number of patients required and the difficulties in selecting the adequate patients. These raise the issues of investigators' experience, coordination and between center variability.

Alzheimer Disease↗
PubMed1984

Phonological recoding for reading: the effect of concurrent articulation in a Stroop task.

The present experiment obtained Stroop and reverse Stroop effects in a card-sorting task where subjects were required to sort cards into bins, labelled with either colour patches or colour names in black ink, under silent and concurrent articulation conditions. Performance by normal subjects and a conduction aphasic supported the notion that concurrent articulation affects post-lexical phonology. It was shown that the status of the hypothesis that pre-lexical phonology is normally used to access meaning during reading (the speech recoding hypothesis) remained uncertain if concurrent articulation only affected post-lexical phonology.

Adolescent↗
PubMed2005

Threshold of regional cerebral blood flow for infarction in patients with acute cerebral ischemia.

Threshold of regional cerebral blood flow (rCBF) for cerebral tissue survival in relation to time was studied in patients with acute cerebral ischemia with xenon-enhanced computed tomography (XeCT). Case 1: A 58-year-old man with right hemiparesis, total aphasia and a high intensity area of 1 cm 2 in the left insula on diffusion weighted image underwent XeCT CBF study before and after intra-arterial local thrombolytic therapy (IALT) on the occluded middle cerebral artery (MCA) 4 hours and 7 hours after stroke onset, respectively. Case 2: A 65-year-old woman with recurrent transient ischemic attacks (TIAs) caused by severe stenosis of the left MCA underwent XeCT CBF study 5 hours after onset of the last attack. XeCT was conducted by 5-min wash-in method. In Case 1 the rCBF in the pre-IALT MCA territory was 4 to 19 ml/100 g/min. The area where rCBF in the post-IALT increased to above 15 ml/100g/min were saved, but the other area where it remained in the 9 to 14 ml/100 g/min evolved into infarct on subsequent CT scan/MR (magnetic resonance) imaging. The patient was discharged with only mild motor dysphasia. In Case 2 the left corona radiata showed rCBF of 7 ml/100 g/min and this area evolved into infarct on MR imaging. The patient was discharged home with right hemiparesis. Our results showed validity of the rCBF threshold in acute cerebral ischemia reported by Jones et al. Residual rCBF in the acute stage of cerebral ischemic stroke can predict the fate of the lesion.

Aged↗
PubMedDate not supplied

[Language and cognitive impairment: a semiological study into visual naming].

INTRODUCTION: The presence of anomia and/or paraphasias in patients with cognitive impairment suggests an associated deterioration of their language. Visual naming makes it possible to examine these signs in a controlled manner as the target word is already known. AIM. To conduct a semiological study of naming in normal aging, cognitive impairment and language impairment conditions. SUBJECTS AND METHODS: The study consisted in an analysis of nine types of signs (correct response, increased latencies, circumlocutions, absence of response, semantic verbal paraphasias, verbal paraphasias with a similar form, unrelated verbal paraphasias, phonemic paraphasias and neologisms) in a visual naming task (6 items), in two groups with normal language--controls > 70 years and patients with Alzheimer's disease (AD) with onset of amnesia--and two groups with language impairment--vascular aphasia and anomic AD-. RESULTS: Patients failed to perform naming correctly in 4.2% of the responses in controls, 10% in patients with amnesic AD, 30% in patients with vascular aphasia and 50% in patients with anomic AD. Semantic paraphasias were observed in the two groups with normal language abilities (controls and amnesic AD), although frequencies were low. Signs that suggest difficulties in accessing/retrieving lexical items were more frequent in patients with AD and ran parallel to the degree of anomia. One notable finding was the absence of signs of phonological dysfunction in the two groups with AD, regardless of the degree of anomia. CONCLUSIONS: Semiological quantification makes it possible to distinguish differences in the degree of anomia and in the pattern of errors both in controls and in patients with amnesic onset AD and among patients with vascular aphasia and neurodegenerative anomia.

Aged↗
PubMed2002

[Provisional diagnostic criteria of corticobasal degeneration (CBD) and the survey of patients with CBD in Japan].

We conducted the survey of patients with CBD in 2001 for 29 neurological institutions in Japan which joined Research Group on Neurodenerative Diseases supported by Ministry of Health and Welfare. Provisional diagnostic criteria of CBD were as follows: "probable CBD" means a clinical category including (1) classical form, consisting of progressive limb-kinetic apraxia and akinetic rigidity, predominant on one side, associated with late dementia, (2) quasi-classical form, revealing other corticobasal signs, predominant on one side, associated with late dementia, and (3) non-classical from, showing early aphasia, dementia, behavior disorder, etc., followed by lateralized limb-kinetic apraxia and akinetic rigidity. "Possible CBD" was not made. "Definite CBD" is pathologically confirmed CBD. There were 151 patients with "probable CBD", comprising 121 patients with classical form, 17 with quasi-classical form and 13 with non-classical from, while patients with "definite CBD" were 13. The number of patients with progressive supranuclear palsy (PSP) was also examined. The ratio of the number of patients CBD/PSP was 1/2.6 in clinical cases and 1/2.5 in autopsy cases. Nakashima et al. performed population survey of PSP patients in Yonago city in 1999, demonstrating prevalence of PSP 4.36/100,000. Considering this rate, the prevalence of CBD is assumed as 1.7 and the presumed number of PSP and CBD patients in 1999 in Japan could be 5,500 and 2,100, respectively.

Humans↗
PubMed2005

Frontotemporal dementia--Part I. History, prevalence, clinical forms.

The authors report a comprehensive publication consisting of three parts going into the details of history, prevalence, clinical forms, differential diagnosis, genetics, molecular pathomechanism, pathology, clinical diagnosis and treatment of frontotemporal dementia (FTD). The first part of the present review deals with history, prevalence and clinical forms of FTD. The prototypical FTD with circumscribed atrophy was first described by Arnold Pick; Alois Alzheimer found the intraneural inclusions in the patients' brain. Later it was recognised that many patients had neither the atrophy nor the cellular changes, but genetic mutations have been identified. Frontotemporal dementia is a degenerative condition with unknown etiology in the frontal and anterior temporal lobes of the brain. It is a progressive neurobehavioral syndrome characterized by early decline in social interpersonal conduct, early impairment in the regulation of personal conduct, early emotional blunting, and early loss of insight. There are no reliable epidemiological studies on the prevalence of FTD, but it is well-accepted that FTD is a common cause for dementia before the age of 65 (it constitutes approximately five percent of all irreversible dementias). The nomenclature of the FTD has been confusing and continues to be. Three major clinical syndromes can be identified: 1 frontal variant FTD (dementia of frontal type) in which changes in social behavior and personality predominate, 2. in semantic dementia (progressive fluent aphasia) there is a breakdown in the conceptual database which underlies language production and comprehension, 3. in progressive nonfluent aphasia the phonologic and syntactic components of language are affected. The authors report two cases, which can point to clinical symptoms and forms, and mention the problems of the differential diagnosis and therapy.

Aged↗
PubMed1984

Colour anomia resulting from weakened short-term colour memory. A case study.

A patient exhibited marked colour anomia without object anomia, but was able to point to named colours. Five experiments were conducted to investigate his immediate colour memory. It was concluded that his colour anomia was the result of an impaired short-term memory deficit specific to colour. Temporary activation of specific entries in the colour lexicon enabled pointing and even naming to take place. A general model incorporating all forms of colour anomia is presented.

Anomia↗
PubMed1999

Comprehension of contrastive stress by Broca's aphasics.

Comprehension of stress as a determiner of reference for pronouns was compared in eight patients with Broca's aphasia (BA) and five age-matched control subjects. The subjects were asked to listen to sentences in which the stressed or unstressed condition of the pronoun was a critical criterion for the establishment of reference. For each sentence, subjects were shown three pictures and asked to point to the correct referent of the pronoun. While the controls were nearly perfect in both the stressed and unstressed conditions, BA patients were significantly worse than normals, showing chance performance in both cases. However, a significant disparity was found in the BA patients' selection of the object NP as the referent under stressed and unstressed conditions, indicating that BA subjects are, indeed, sensitive to the stress patterns of pronouns. It was thus hypothesized that the BA patients' chance performance was the result of an inability to implement their knowledge of stress during the processing of sentences involving discourse-related linguistic operations, such as the establishment of pronoun reference (Grodzinsky, Wexler, Chien, Marakovitz, & Solomon, 1993). To test this hypothesis, a second experiment was conducted in which discourse-related operations were eliminated. In this second experiment, comprehension of stress by the same two groups was compared in tasks involving purely morphosyntactic processes. The contrastive stress patterns of otherwise homophonous compound nouns and adjectival phrases (e.g., BLACKboard, black BOARD), rather than those of pronouns, were examined. In this grammatically "simpler" experiment (i.e., without discourse-related operations), BA subjects scored significantly above chance in their comprehension of sentences involving compound nouns; unexpectedly, however, these same subjects did not show significantly above-chance performance in their comprehension of sentences containing adjectival phrases. Nevertheless, the results obtained in these two experiments seem to support the view that aphasic patients may have a lack of processing capacity, resulting in more errors during the processing of discourse-related linguistic constructions.

Aged↗
PubMed1986

Altered acoustic cue discrimination in Broca's and conduction aphasics.

The present investigation explored the acoustic cue discrimination abilities of eight Broca's and four conduction aphasic patients and nine normal controls. A word-discrimination test was used to assess the subjects' ability to discriminate selected acoustic cues for distinctive features of phonemes. The words differed from one another by a selected minimal feature, such as stop-gap duration, duration of fricative noise, direction and extent of final format transition, or relative location of friction noise in the spectrum. Results indicated that performance for normal and aphasic subjects was poorer for altered temporal subtest items than for altered spectral subtest items. Within the spectral subtest, fewer Broca's aphasics than conduction aphasics passed the items, while 90% of the normals passed. Within the temporal subtest, fewer conduction aphasics than Broca's aphasics passed the items, while 75% of the normal subjects passed this subtest. The results support previous research suggesting that deficiencies in auditory processing of selected acoustic cues are not limited to Wernicke's aphasic individuals but may be found to a varying degree in several aphasic groups.

Adult↗
PubMed2001

Quality of life of stroke survivors: a research synthesis.

Stroke is the third leading cause of death and a major cause of disability in the United States. Individuals experiencing a completed stroke are faced with a multitude of challenges to restore their highest quality of life within the limitations of residual impairment. This research synthesis provides a summary of previous research on quality of life for stroke survivors. Research studies for inclusion in the review were identified by conducting a search of computerized databases through August 2000 and by using the ancestry method of reviewing reference lists from relevant publications. Thirty-nine studies were identified that focused on stroke survivors' quality of life during the recovery process. Stroke survivors' overall quality of life varied based on the country where the study was implemented. Variables positively associated with stroke survivors' quality of life were independence with activities of daily living, increased functional ability, social support, and healthcare resources. Variables negatively associated with stroke survivors' quality of life were psychological impairment, severity of impairment, severity of aphasia, inappropriate reactions to illness and pessimism, and inability to return to work. Specifically, 22% to 73% of the variance in stroke survivors' quality of life was primarily explained by presence of depression; functional ability, especially the upper extremities; and socialization, in particular, leisure activities. Implications for professional nursing practice to enhance stroke survivors' quality of life include encouraging independence, managing depression, and fostering interpersonal relationships. Areas for future research include longitudinal studies, rigorous psychometric assessment of quality of life instruments, and intervention studies.

Aged↗
PubMed2005

Large facial nerve schwannomas without facial palsy: case reports and review of the literature.

Although approximately 30% of facial nerve schwannoma cases present with no facial palsy, a large facial nerve schwannoma extending to the middle and posterior cranial fossa quite rarely presents without facial palsy. The authors encountered two patients with large facial nerve schwannoma who presented with only hearing impairment and no facial palsy. The first patient was a 64-year-old woman who presented with right auditory impairment without facial palsy. MR images demonstrated a dumbbell-shaped tumor in the cerebellopontine angle. Another patient, a 40-year-old woman, also presented with vertigo and right tinnitus without facial palsy. MR images demonstrated a huge tumor expanding into both the posterior cranial fossa and middle cranial fossa. In both cases, intraoperative findings confirmed that the tumors had grown from the facial nerve. Facial nerve schwannoma can be easily diagnosed if detailed neurological evaluations and appropriate neuroimagings are conducted. However, in spite of such huge tumoral size and expanding pattern, the facial nerve function was relatively preserved. Anatomical features of the facial schwannoma are discussed. A tumor extending to the middle and posterior cranial fossa should remind neurosurgeons to consider facial nerve schwannomas even in the absence of facial palsy.

Aged↗