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PubMed1994

Auditory brainstem responses of children with developmental language disorders.

Brainstem auditory evoked potentials (BAEPs) were recorded from 48 children with language disorders (aged four to nine years old, IQs normal to borderline, normal audiometric thresholds and attending special school) and 20 healthy children (four to eight years old, with normal IQs, audiometry and school-level). The language-disabled group showed significantly lower absolute latency values of the BAEPs than controls. There were no significant differences in the central conduction time of the auditory pathway (I-V interval). Therefore, the only significant difference corresponded to a minor value for the first wave (auditory nerve discharge) of the BAEP. A reduction in the control mechanisms of the sensory inputs at the peripheral level, or a disturbance in the inhibitory mechanisms of cortico-subcortical modulation, might explain these findings.

Aphasia↗

PubMed2005

[The peculiarities of speech disturbance in patients with arteriovenous malformations of the caudate nucleus and the thalamus].

Clinical and neuropsychological study of 28 patients with arteriovenous malformations (AVM) of the caudate nucleus and 36 patients with AVM of the thalamus has been conducted. After surgical removal of the caudate nucleus, speech disturbances developed in 4 out of 8 patients with left-side AVM and in 1 patient, a converted left-hander, with right-side AVM. All 5 patients had mild speech disturbances, which differed by character in dependence of the AVM location. In case of AVM location in the head of the caudate nucleus, the speech disturbances were represented by perseverations and were similar to those caused by the lesion in the Broca area. In case of the caudate nucleus lesion, naming was mildly affected that resembled temporal aphasia. After surgical removal of AVM in the left thalamus in 9 patients, complex and rather stable speech disturbances developed in 7 cases. They were featured by the signs of frontal and temporal aphasias, i.e. there were perseverations and disturbances of naming, auditory and speech memory. The peculiarities of speech disturbances in lesions of the caudate nucleus and the thalamus were well explained by their anatomic and functional correlations with different regions of brain speech cortex. Speech disturbances in various subcortical lesions are reviewed. In the authors' opinion, subcortical aphasias do not have any particular character but include the same factors in different combinations as cortical ones that is determined by the presence of common functional systems for speech support which comprise cortical and subcortical patterns.

Adolescent↗

PubMed2000

Verb retrieval in brain-damaged subjects: 1. Analysis of stimulus, lexical, and conceptual factors.

Verb retrieval for action naming was assessed in 53 brain-damaged subjects by administering a standardized test with 100 items. The goal of the study was to gain further insight into the nature of verb processing impairments by investigating the influence of several kinds of stimulus, lexical, and conceptual factors on the subjects' performance at the level of group tendencies and also at the level of individual differences. (1) Stimulus factors: visual complexity, familiarity, image agreement, and one vs. two pictures (which corresponds to ongoing vs. completed actions); (2) lexical factors: name agreement, verb frequency, and whether the root of the target verb has a homophonous noun; (3) conceptual factors: whether the action is done with the hand or the body, whether the action involves one or two core participants, whether the undergoer of the action has a change of internal state, whether the undergoer has a change of spatial location, and whether the actor makes use of an instrument in carrying out the action. The subjects were divided into an impaired group (n = 19) and an unimpaired group (n = 34) on the basis of their overall performance on the test. For both groups of subjects, verb retrieval was significantly affected by the following factors: familiarity, image agreement, name agreement, homophonous noun, and undergoer change of location. These results indicate that, at the level of group analysis, some factors have a stronger influence on verb retrieval for action naming than others. Moreover, the finding that the two groups exhibited the same general pattern of factor sensitivity suggests that although the processing efficiency of the mechanisms that subserve verb retrieval is degraded in the impaired group, the basic functional properties of these mechanisms may not be qualitatively very different from those of the unimpaired group. Further analyses were conducted at the level of individual subjects and revealed a considerable amount of variation with regard to factor sensitivity. Many patterns of associations and dissociations of factors were found across the subjects, which suggests that the task of retrieving verbs for naming actions is quite complex and that different subjects can be influenced by different properties of both the stimuli and the target verbs.

Aphasia↗

PubMed2005

Acute thromboembolic events during carotid artery angioplasty and stenting: etiology and a technique of neurorescue.

PURPOSE: To review the protected carotid stenting experience at two major referral centers to evaluate the frequency of clinically significant intraprocedural thromboembolic events, use of neurorescue techniques, and ultimate clinical outcomes. METHODS: A retrospective review was conducted of 254 cases of protected transfemoral carotid stenting performed at the Washington University-Barnes Hospital and The Fleni Institute of Buenos Aires in a 6-year period. Medical records of patients with periprocedural thromboembolic events were reviewed to determine the type of complication, method of treatment, and outcome. RESULTS: Among the 254 cases in which a carotid protection device was used, 2 (0.79%) episodes of witnessed, symptomatic thromboembolism occurred. Both patients suffered thromboembolic occlusion of the M1 branch of the middle cerebral artery (MCA) immediately following crossing of the internal carotid lesion with the protection device. Neurological symptoms consisted of agitation, aphasia, and hemiplegia in both patients. After rapid stent deployment across the carotid lesion, the MCA was cannulated and the occlusion treated with balloon angioplasty. This was followed by selective intra-arterial delivery of urokinase and intravenous abciximab. These maneuvers resulted in excellent restoration of blood flow in the MCA and its branches. With the exception of minor word-finding difficulties in one, both patients demonstrated full neurological recovery within the perioperative period. CONCLUSIONS: In our experience, intraprocedural thromboembolic events occur despite the use of cerebral protection devices, but are rare. Notably these complications appeared to occur at the time of lesion crossing by distal cerebral protection devices. These thromboembolic events can be successfully treated if the complication is rapidly identified and the physician is adequately prepared and proficient in neurorescue techniques.

Abciximab↗

PubMed1998

Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease.

BACKGROUND: In many patients with idiopathic Parkinson's disease, treatment with levodopa is complicated by fluctuations between an "off" period, when the medication is not working and the motor symptoms of parkinsonism are present, and an "on" period, when the medication is causing improved mobility, often accompanied by debilitating dyskinesias. In animal models of Parkinson's disease, there is overactivity in the subthalamic nucleus, and electrical stimulation of the subthalamic nucleus improves parkinsonism. We therefore sought to determine the efficacy and safety of electrical stimulation of the subthalamic nucleus in patients with Parkinson's disease. METHODS: We studied 24 patients with idiopathic Parkinson's disease in whom electrodes were implanted bilaterally in the subthalamic nucleus under stereotactic guidance with imaging and electrophysiologic testing of the location. Twenty were followed for at least 12 months. Clinical evaluations included the Unified Parkinson's Disease Rating Scale, a dyskinesia scale, and timed tests conducted before and after surgery, when patients were off and on medications. RESULTS: After one year of electrical stimulation of the subthalamic nucleus, the patients' scores for activities of daily living and motor examination scores (Unified Parkinson's Disease Rating Scale parts II and III, respectively) off medication improved by 60 percent (P<0.001). The subscores improved for limb akinesia, rigidity, tremor, and gait. In the testing done on medication, the scores on part III improved by 10 percent (P<0.005). The mean dose of dopaminergic drugs was reduced by half. The cognitive-performance scores remained unchanged, but one patient had paralysis and aphasia after an intracerebral hematoma during the implantation procedure. CONCLUSIONS: Electrical stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease. The severity of symptoms off medication decreases, and the dose of levodopa can be reduced with consequent reduction in dyskinesias.

Activities of Daily Living↗

PubMed1992

Lexical tones in Thai after unilateral brain damage.

An acoustic perceptual investigation of the five lexical tones of Thai was conducted to evaluate the nature of tonal disruption in patients with unilateral lesions in the left and right hemisphere. Subjects (n = 48) included 10 young normal adults, 10 old normal adults, 11 right hemisphere nonaphasics, 9 left hemisphere fluent aphasics, and 8 left hemisphere nonfluent aphasics. The five Thai tones (mid, low, falling, high, rising) were produced in isolated monosyllables, presented for tonal identification judgments, and measured for fundamental frequency (Fo) and duration. Results of an analysis of variance indicated that left hemisphere nonfluent speakers signaled and tonal contrasts at a lower level of proficiency. The extent of their impairment varied depending on severity level of aphasia. When compared to normal speakers, tonal identification for less severe nonfluent aphasics differed more in degree than in kind, and for more severe nonfluent aphasics differed both in kind and in degree. Acoustic analysis revealed that with the exception of one left nonfluent, average Fo contours were comparable in shape across speaker groups. Variability in Fo production, however, was greater in left nonfluent speakers than in any of the other four groups of speakers. Issues are discussed regarding the extent and nature of tonal disruption in aphasia and hemispheric specialization for tone production.

Adult↗

PubMed1999

Group therapy for spouses of aphasic patients.

The setting, course, and results of a counseling and a therapeutic group for relatives of chronic aphasic patients are reviewed. Generally, providing and discussing information on the illness, its consequences, and medical and social services are greatly appreciated by group members. Counseling and group psychotherapy, as conducted by us, did not result in measurable improvements of relatives' perceptions of personal, social, and familial burdens. We assume, however, that group therapy does lead to more realistic attitudes toward burdensome and severely straining situations and may help with coping. Further research into psychotherapeutic strategies for relatives of disabled persons, who themselves suffer from psychological and social handicaps, is needed.

Adaptation, Psychological↗

PubMed2004

Extended middle fossa approach to the petroclival junction and anterior cerebellopontine angle.

OBJECTIVES: This article seeks to demonstrate the use of the extended middle cranial fossa approach in the treatment of tumors arising in the anterior cerebellopontine angle and petroclival region. STUDY DESIGN: We conducted a retrospective chart review. SETTING: Tertiary referral center. PATIENTS: : Ten-year retrospective chart review of over 800 skull base surgical cases demonstrated 16 cases in which the senior author used the extended middle cranial fossa as the sole approach to access the posterior cranial fossa, petroclival junction, or the anterior cerebellopontine angle. There were five males and 11 females, 13 meningiomas, 2 trigeminal schwannomas, and 1 brainstem glioma. Presenting symptoms were dependent on extent of brainstem compression and involvement of surrounding cranial nerves. The symptoms are broken down as follows: hydrocephalus, one; balance disturbance, three; diplopia, five; trigeminal neuralgia, two; hemifacial numbness, one; seizures, one; expressive aphasia, one; and hearing loss, two. RESULTS: Of the 16 patients in this study, one patient needed postoperative care in a skilled nursing facility. Postoperative facial nerve weakness was not experienced in any patient. One patient developed a transient cerebrospinal fluid leak that resolved spontaneously. One patient developed a pseudomeningocele secondary to postoperative hydrocephalus. This was corrected with wound exploration and placement of a ventricular peritoneal shunt. Hearing was not maintained in one patient. Two patients developed new fourth nerve paresis and two patients developed new sixth nerve palsies. There were no postoperative infections and no deaths. CONCLUSIONS: The extended middle cranial fossa approach provides excellent access and exposure to tumors in the anterior cerebellopontine angle and petroclival junction. The approach allows more direct access to the area anterior to the internal auditory canal. The key to the approach is adequate bone removal of the petrous apex to provide exposure down to the inferior petrosal sinus and anteriorly to Meckel's cave and the petroclival junction. Extradural elevation of the temporal lobe with suitable brain relaxation minimizes postoperative complications.

Adult↗

PubMed2005

[A case of arteria cerebri aneurysm, sepsis, and miliary lung infiltrates in a 32-year-old woman].

BACKGROUND: Miliary tuberculosis is a rare manifestation of tuberculosis with a high mortality rate. Diagnosis may easily be missed when severe neurologic symptoms are the first clinical manifestation. A typical case of miliary tuberculosis is reported, with special regard to the problems of diagnostic work-up. The need for an early empirical therapy for suspected military tuberculosis is emphasized in particular. CASE REPORT: A 32-year-old Moroccan woman was admitted to the hospital with aphasia and a hemiparesis due to an intracerebral hemorrhage caused by a ruptured septic A. cerebri media aneurysm. Despite intensive work-up no septic focus could be found. Chest radiograph and computerized tomography (CT) showed miliary consolidations in the lungs. Skin testing (Tuberkulin Behring GT5) and smears for acid-fast bacilli and polymerase chain reaction (PCR) for tuberculosis of bronchoalveolar lavage (BAL) were negative. A four-drug antituberculous regimen (rifampicin [RMP], isoniazid [INH], pyrazinamide [PZA], ethambutol [EMB]) was initiated, and resulted in normalization of temperature, blood pressure, and C-reactive protein. Subsequently, cultures of BAL yielded Mycobacterium tuberculosis. The patient was discharged, a two-drug regimen was conducted (RMP, INH) after 2 months. Follow-up of the patient showed a significant improvement of the miliary lung consolidations after 5 months in CT of the lung. Only minor neurologic symptoms persisted after cessation of the therapy. CONCLUSION: In developed countries, miliary tuberculosis is a very rare cause of septic infiltrative lung disease. However, due to the nonspecific nature of the presentation and despite improved diagnostic techniques, a high clinical suspicion is essential for successful treatment.

Adult↗

PubMed1991

An investigation of naming errors following semantic and phonemic cueing.

This study investigated the types of verbal errors produced by aphasic patients following phonemic and semantic cueing. Twenty-eight aphasic patients--10 Broca's, 10 Wernicke's and 8 conduction aphasics--served as subjects. Semantic and phonemic cues were administered on object and action confrontation-naming tasks. When subjects did not respond correctly to phonemic cueing, a significantly greater number of phonemic errors were produced, with a concurrent decline in related words and extended circumlocutions. When subjects failed to respond to semantic cueing on the action task, there was an increase in a number of error categories.

Anomia↗

PubMed2004

[A case of dementia with motor neuron disease associated with agraphia--the omission of kana letters].

We report a 55-year-old right-handed Japanese man with motor neuron disease and dysgraphia of kana letters. He was admitted to our hospital because of dysarthria and dysphasia. On admission, the results of general physical examination were within normal limits. Neurological examination revealed severe dysarthria, dysphasia, impaired movement of the tongue without fasciculation and slight distal muscle weakness in the bilateral upper limbs. There were no fasciculation of the muscle. Deep tendon reflexes were hyperactive without Babinski's signs. Sensation, coordination, and gait were normal. Neurophysiological studies demonstrated normal motor nerve conduction velocities and sensory action potential. The results of needle electromyography of the upper limbs were compatible with motor neuron disease (MND). Magnetic resonance imaging (MRI) showed atrophy of the bilateral temporal region of the brain. 99mTc-HMPAO SPECT (Single Photon Emission Computed Tomography) showed reduced uptake of tracer in the bilateral temporal region. On neuropsychological examination, his behavior was normal, and orientation and intelligence were also preserved, but his speech was severely impaired. Reading comprehension was slightly impaired. In regard to writing comprehension, he had no difficulty in copying of words though dictation was found to be impaired. He omitted one kana letter in a word. Agraphia is accompanied by various factors such as aphasia, dementia, agnosia, alexia. But in this case at least for early stage, agraphia existed without other higher cortical dysfunction. He did not show severe dementia in his early stage of his disease, but developed it later in the disease's progression. In this case, agraphia might be due to the atrophic changes in the temporal lobe.

Agraphia↗

PubMed1976

[Disorders of the emotional behavior during cerebral lesions].

A systematic study of the emotional behavior of right and left brain-damage patients was conducted on large groups of patients with unilateral cerebral lesions. The incidence of "catastrophic reactions" was found to be significantly higher among the left brain-damaged patients, whereas "indifference reactions" were significantly more frequent in the group with right-sided lesions. The depressive-catastrophic reactions of left brain-damaged patients seemed due chiefly to marked difficulties in verbal expression, while the indifference reactions of the right brain-damaged patients were highly correlated with neglect phenomena for the opposite half of the body and of space. The meaning of the emotional reaction shown by left brain-damaged patients seems easy to understand, if we consider that these subjects are affected by aphasia and by a paresis of the right hand. More surprising and paradoxical is, on the contrary, the emotional behavior of the right brain-damaged patients. The hypothesis is advanced that the indifference of these subjects may be only apparent, and due to a strong need of denying illness. The prevalence of denial of illness among the right brain-damaged patients could be due to the "non verbal" functional organization which is supposed to be characteristic of this half of the brain.

Affective Symptoms↗

PubMed1992

Impairment of inflectional morphology and lexical storage.

The present study investigates the repetition, comprehension, and production abilities of three French-speaking agrammatic aphasics on stimuli that require attention to the inflectional markers of number, gender, and tense. Two sets of experiments were conducted within a Strong Lexicalist framework. The results suggest that morphological deficits can manifest themselves at distinct levels of grammar, the lexical and the postlexical. The internal morphological structure and idiosyncracies of lexical items were found to have an effect on aphasic performance. A proposal of a differentially organized lexical storage reflecting the particularities of the French verbal system is put forth. The storage hypothesis suggested for verbs is extended to other lexical items.

Aphasia, Broca↗

PubMed1998

Bilingual performance on the boston naming test: preliminary norms in Spanish and English.

A total of 100 young educated bilingual adults were administered the Boston Naming Test (BNT) (Kaplan, Goodglass, & Weintraub, 1983) in both Spanish and English. Three group performance scores were obtained: English only, Spanish only, and a composite score indicating the total number of items correctly named independent of language. The scores for the entire group were significantly greater in English than in Spanish. An additional set of analyses explored individual differences in picture naming performance across the two languages as measured by the BNT. For a subset of the larger group (n = 25) there were significant differences in composite over single language scoring, but no significant differences between Spanish and English. Item analyses of correct responses were conducted in both languages to explore the construct validity of the standardized administration of the BNT with this population. There was much greater variability in responses over the Spanish items for this bilingual group. The results of a correlation analysis of information obtained from the initial questionnaire with the BNT scores in each language is also reported. The practical implications of this preliminary bilingual BNT normative data are discussed.

Adolescent↗

PubMed1996

The representation of arithmetical facts: evidence from two rehabilitation studies.

We report the improvement following rehabilitation of two patients with a selective deficit on multiplication facts. The remediation experiments were conducted in specific designs to test a series of hypotheses about both the process of reacquisition and organisation of arithmetical facts in memory. The results show a significant and stable recovery and the pattern of reacquisition reflects the different strategy used by the patients to relearn the multiplication facts. Quantitative and qualitative changes in error patterns in the course of remediation reveal the underlying (re)organization of the memory network representing multiplication facts.

Adult↗

PubMed1995

The effects of topic and listener familiarity on discourse variables in procedural and narrative discourse tasks.

This study investigated the effects of listener and topic familiarity on procedural and narrative discourse variables. Twenty-two aphasic patients (5 Broca's, 7 conduction, and 10 anomic aphasics) and 10 normal speakers served as subjects. Topic familiarity influenced discourse production in both procedural discourse and story retell situations. In procedural discourse, a greater number of optional steps were provided with familiar topics. During retelling of familiar topic stories, a greater proportion of action and resolution clauses were included. Listener familiarity affected the story retell task only. A greater percentage of subjects provided the setting when the listener was familiar.

Aged↗

PubMed1987

Failure of long term high-dose lecithin to retard progression of early-onset Alzheimer's disease.

We conducted a six-month, randomized, double-blind trial of lecithin therapy in early-onset Alzheimer's disease. We hypothesized that such therapy would retard the progression of the clinical and neuropsychological manifestations of this illness. Of the 73 referred patients, 37 met strict requirements for diagnosis and compliance. The 21 placebo and 16 lecithin-treated patients (mean age 63 years) had a comparable degree of severity of dementia (mean Clinical Dementia Rating 1.6). Lecithin therapy produced an increase in mean plasma choline levels from a baseline of 15.9 to 28.8 nmol/ml. Patients were evaluated by the physician using clinical assessments (CDR, Lawton ADL and other rating scales) and by the neuropsychologist who determined the outcome of therapy on a battery of tests (Mini Mental State Examination, Wepman Aphasia Screen, Verbal Fluency Test, Verbal Selective Reminding Test and Spatial Memory Test). Only 6 (37.5%) of the 16 lecithin-treated patients were considered by the neurologist to be clinically stable or improved as compared to 12 (57.1%) of the 21 patients given placebo (difference -19.6%, 95% confidence limits of -51% to 12%). The neuropsychologic scores showed no differences in the stability of the dementing process over time between the lecithin-treated (50.0%) and placebo (47.6%) groups. On the basis of these clinical and neuropsychological findings, it appears that lecithin alone has no important therapeutic effect in early-onset Alzheimer's disease.

Alzheimer Disease↗

PubMed1993

Cognitive impairment, dementia and psychosocial functioning in human immunodeficiency virus infection. A prospective study based on DSM-III-R and ICD-10.

Progressive cognitive impairment in human immunodeficiency virus (HIV) infection, called acquired immunodeficiency syndrome (AIDS) dementia complex (ADC), significantly influences the social prognosis of afflicted patients. The frequency and character in different stages of the infection are controversially discussed. In previous studies, differences in the selection of patients and methods of testing led to widely differing results. For these reasons, in the present prospective study on 45 HIV-infected patients, a structured psychiatric interview (SIDAM) was conducted based on the algorithm of diagnosing dementia in DSM-III-R and the ICD-10 guidelines. The psychopathological findings are expressed in syndrome scores; the results are summarized in a total score (SISCO). The interview contains the Mini-Mental State Examination. The degree of psychosocial functioning was estimated on the global assessment of functioning, Axis V of DSM-III-R. In stages preceding AIDS, only slight cognitive dysfunction was found compared with age- and education-matched normal controls, and this caused no relevant disturbance of psychosocial functioning. In 9 patients with manifest AIDS, dementia was diagnosed with DSM-III-R criteria and ICD-10 guidelines (30% of the AIDS patients). They showed marked impairment of intellectual ability, memory, verbal ability and calculation and constructional ability and fewer cortical focal symptoms (aphasia and apraxia). Corresponding to previous studies, major cognitive dysfunction in HIV infection can be characterized as subcortical dementia.

AIDS Dementia Complex↗