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PubMed1994

[Multimodal or multisensorial agnosia?].

A 75 year-old right handed woman had persistent right homonymous hemianopia and alexia without agraphia caused by a haemorrhagic stroke of the left occipito-temporal region. Six months later she suffered sudden onset visual and auditory agnosia, following a second haematoma, contralateral to the first one, in the right occipito-temporal region including the lingual and fusiform gyri. None of the disorders concerned semantic representation, so that an asemantic agnosia was excluded. Her performance in naming and recognition tests, in both visual and auditory modalities, demonstrated a wide range of responses and errors. The pattern of visual symptoms suggested "associative visual agnosia narrow sense" (Farah, 1990); auditory agnosia concerned only the non verbal stimuli. These findings were discussed in terms of anatomical mechanisms subserving perceptual, semantical, visuo and auditory-verbal representation. In this case, visual and auditory, agnosia appears to be independent.

Aged↗
PubMed1975

[The death of Ravel].

The composer Maurice Ravel (1875-1937) was chronically ill during the last five years of his life. He was suffering from Pick's astrophy, the first signs of which appeared in 1923 and 1927 and which were probably already reflected in the stereotypy of the "Bolero" of 1928. Transient apractic symptoms were prominent, later, difficulty in finding words, agraphia and alexia. Ravel left no completed composition after an accident to the head in 1932. Complete apathy and involutional phenomena characterize the period before the death of the master, who passed away a few days after a surgical operation on the brain.

Dementia↗
PubMed1994

Dyslexia: a neuroscientific puzzle.

The initial assumptions as to the existence of neurodevelopmental disorders have been confirmed by almost a century of studies focused on the nature and causes of reading disability. Dyslexia is an umbrella term for the various manifestations of reading disabilities, each of which is related to its own complex of neuropsychological dysfunctions, sometimes accompanied by neurological symptoms that can be indicative of the specific location involved. Electro-physiology and neuro-imaging in relation to metabolic activity have also confirmed that, to some extent, there is dysfunction in various cerebral areas, more frequently in the left than in the right hemisphere, less often between the hemispheres (corpus callosum) and outside the classical language areas. The rather rare subtype referred to as visual dyslexia and the inter-modal disconnection type resembling alexia are eclipsed by dyslexias related to spoken language: the dysphonemic (auditory-phonological) subtype and the subtypes that are concerned with the production of speech (fluency, word-finding, syntax, sequences), semantics (language comprehension) and linguistic memory. Although it is considered that there are basic brain dysfunctions in dyslexics such as deficits in sequential information processing, there is no "grand unified theory" of dyslexia. There are some new insights as regards the aetiology. In addition to indications of such possible causes as perinatal brain damage, genetic or chromosomal anomalies that manifest themselves in the substrate in an unclear manner, there is also the possibility that the cortical language areas can be disturbed in their development (migration disorders and abnormal asymmetry) due to genetic or epigenetic hormonal and/or immunological factors, so that the normal left hemispheric dominance does not develop. The diagnosis and treatment of dyslexia should begin at an early age and should be acknowledged as being of great social importance.

Brain↗
PubMed1994

The knowledge and attitudes of occupational therapy, physiotherapy and speech-language therapy students, regarding the speech-language therapist's role in the hospital stroke rehabilitation team.

The purpose of the present study was to survey and compare the knowledge and attitudes of final year occupational therapy, physiotherapy and speech-language therapy students, concerning the role of the speech-language therapist as a member of the stroke rehabilitation team in the hospital setting. In order to achieve this aim, a questionnaire was administered to final year students in these three disciplines, and included questions on most areas of stroke rehabilitation with which the speech-language therapist might be involved, as well as the concepts of rehabilitation and teamwork in relation to stroke rehabilitation. Results suggested a fairly good understanding of the concepts of rehabilitation and teamwork. Students appeared to have a greater understanding of those disorders following a stroke, with which the speech-language therapist is commonly involved, such as Aphasia, Dysarthria, Verbal Apraxia and Dysphagia. However, students appeared to show less understanding of those disorders post-stroke, for which the speech-language therapist's role is less well defined, such as Agraphia, Alexia and Amnesia. In addition, a high percentage of role duplication/overlapping in several aspects of stroke rehabilitation, such as family and social support, was found. Several implications for facilitating communication, collaboration and understanding between paramedical professions, as well as for further research are also provided.

Cerebrovascular Disorders↗
PubMed1996

[Vision disorders in retrochiasmatic lesions of the visual pathways].

Anatomic elements of the retrochiasmatic pathway. Synopsis of homonymous pathway. Synopsis of homonymous hemianopia: unilateral forms [quadrant, total], bilateral forms [tunnel field, cerebral blindness], homonymous scotomas, horizontal hemianopsias, checkerboard hemianopsias, sparing of temporal crescent. Additional disorders: hemi-neglect, color agnosia, hemi-achromatopsia, alexia, abnormal optokinetic nystagmus, cog-wheel pursuit movement, hemianopic pupillary defect, statokinetic dissociation [Riddoch phenomenon], hallucinations, illusions, visual agnosia, prosopagnosia.

Aged↗
PubMed1996

[Progressive aphasia without dementia--the onset of an atrophic process of the brain].

Three cases of progressive aphasia were analyzed. Moderate motor aphasia without any cognitive disturbances was observed at an early stage of the disease. Subsequently gradual development of severe motor aphasia, agraphia, alexia, as well as of speech comprehension disorder, intellectual retardation, aspontaneity, and apraxia was observed in such patients. Computer tomography revealed brain fronto-temporal local atrophy which was growing progressively as far as the disease developed. Any cerebrovascular diseases were absent. The conclusion was made that progressive isolated aphasia was the debut of cerebral cortex atrophy.

Aged↗
PubMed1996

[Preserved implicit reading and the recovery of explicit reading in a pure alexic].

We described a 55-year-old, right-handed, university-educated Japanese man who showed pure alexia after an infarction in the territory of the left posterior cerebral artery. Damage to the corpus callosum was limited to the most caudal part of the splenium. In the early days of his illness, he demonstrated the inability to read aloud on either Kana (Japanese syllabograms) or Kanji (Japanese morphograms). In contrast, he could semantically categorize Kanji-words such as animals or non-animals. Subsequently, he gradually regained the ability of reading aloud Kanji as well as Kana. At that time, we further investigated the relation between his reading ability and the attributes of 881 Kanji characters including hieroglyphicity, concreteness, and familiarity. We found that he could more readily read Kanjis with higher hieroglyphicity, concreteness, and familiarity. The reading times for Kanji-words were significantly shorter than those of corresponding Kana-words. Moreover, he showed some difficulty to read Kana-words and Kana combinations without meaning when asked to perform repetitive opposing movements with his thumb and little finger inhibiting kinesthetic reading. The effect was not observed when he read Kanji-words. These results lead us to suggest the following: (1) the two components of reading, reading aloud and comprehension abilities, are dissociable in a pure alexic, especially in Kanji reading; and (2) recovery mechanisms underlying Kanji and Kana reading were different in our case. Namely, restitution of the direct connection through the residual splenium fibers between the visual word form processing area in the right hemisphere and the left angular gyrus was attributed to Kanji reading, and utilization of kinesthetic reading played an important role in Kana reading.

Dyslexia, Acquired↗
PubMed1995

[A case of integrative visual agnosia].

We report a 78-year-old right-handed man with integrative visual agnosia (Humphreys et al.) that was associated with bilateral medial occipito-temporal infarction. The patient showed superior altitudinal hemianopsia, alexia, prosopagnosia, cerebral achromatopsia, and object agnosia. Elementary perception and information processing supposed to be executed by the stream to the parietal lobe were intact, since he was able to perceive the position and speed of moving object (catching the flying ball). He could not categorize neither real objects nor line drawings by sight. However, copying and matching of them was accurate, suggesting that his agnosia was an associative type (Lissauer). Detailed neuropsychological examinations revealed that his agnosia was due to a disturbance in integrating local form features into a perceptual whole. In addition, this patient showed difficulty in retrieval of objects from memory. However, it is unlikely that this disturbance itself was a cause of this particular form of agnosia.

Aged↗
PubMed1995

[Transient achromatopsia caused by cardioembolic brain ischemia].

A 51-year-old right-handed man with dilated cardiomyopathy, sleep apnea and atrial fibrillation suddenly suffered from transient color imperception, which completely recovered next morning. During the attack, both color naming and color pointing were severely disturbed, while he could correctly state the colors of named objects. There were no additional neuropsychological disturbances such as aphasia, alexia and prosopagnosia. Brain MRI revealed a new ischemic change, i.e. laminar cortical necrosis, in the right fusiform gyrus as a causative lesion as well as old asymptomatic infarcts in the left middle cerebral arterial territory. Cardioembolism was considered to be responsible for the development of brain ischemia. The transient achromatopsia is a rarely reported disease and this case appears to support 'ischemia' as its etiology.

Brain Ischemia↗
PubMedDate not supplied

[Neuropsychological study of mental troubles in normal pressure hydrocephaly and their short term evolution after spinal fluid derivation (author's transl)].

Starting with 8 neuropsychological detailed observations, the author has studied mental deterioration resulting from normal pressure hydrocephaly and the short term evolution of mental troubles after apinal fluid derivation. The presurgical mental troubles are characterized essentially by short term memory troubles, by behavioural troubles relating to the two poles of the frontal syndrome and by distrubances in writing and calculus. The modification of the state of consciousness, the visual constructive troubles, attention and concentration troubles, verbal language troubles and psychomotor retardation are also frequent. Aphasia and alexia are rare. Generally, postsurgical evolution is immediate and global; the troubles of consciousness, mental deterioration and behaviour disorders are parallely reduced. Globaly, three out of four troubles disappear. Memory troubles and difficulties in concentrating, although improving, are still maintained six month after ventricular drainage.

Adolescent↗
PubMed1997

[Developmental dyslexia and dysgraphia--a case report].

We reported a 7-year-old, right-handed boy whose reading and writing of kana and kanji were impaired. He also showed a severe deficit in visuo-spatial perception skills. Nevertheless, his ability to read and write kana characters was facilitated by means of the Japanese Syllabaries. It is generally considered that the Syllabary involve two kinds of language modalities: auditory-verbal and visuo-verbal language systems. In spite of his intact auditory-verbal language system, his visuo-verbal language skills involved in writing kanji were severely impaired. It was suggested that a severe deficit of visuo-spatial perception skills influenced performance of visuo-verbal language systems. Accordingly, we inferred that the patient recalled a kana character by use of the Japanese Syllabaries based on his good auditory-verbal language system, and supposed that his reading and writing disorders were similar to alexia with agraphia in adult patients with angular lesions.

Agraphia↗
PubMedDate not supplied

[Acalculia].

Acalculia is an acquired disturbance of calculation that has several clinical expressions. Disturbances cna be aphasic and nonaphasic. Further division is into alexia and agraphia for numbers, anarithmetria and spatial acalculia. In addition to these manifestations due to focal cerebral lesions also diffuse lesions can produce disturbance of calculia. Acalculia is also encountered as a developmental disturbance. Testing of acalculia has to encroach both oral and written calculations with clinical and standardized neuropsychological tests.

Aphasia↗
PubMed1998

[A patient with amnesic syndrome with defective route finding due to left posterior cerebral artery territory infarction].

We report a right-handed 67-year-old woman with an infarction in the left posterior cerebral artery territory presenting amnesic syndrome, right homonymous hemianopsia, pure alexia, color anomia, and defective route finding. The patient often walked in wrong directions out of her hospital room as well as in her home. She was able to recognize her own house and nearby streets by looking at them. Prosopagnosia and constructional impairment was not observed. Wechsler memory scale revised (WMS-R) revealed that she had marked disturbance in both visual and verbal recent memory. Brain MRI revealed an infarction involving the left medial inferior temporal and left medial occipital lobe, the left splenium of corpus callosum, and the left retrosplenial region. SPECT indicated a defect in the left medial occipital lobe and hypoperfusion in the left medial temporal lobe. Cerebral angiography demonstrated stenosis of the left medial occipital artery and occlusion of the left dorsal corpus callosal branches and the left calcarine artery. We conclude that left hippocampus, left parahippocampal gyrus and the left retrosplenial region may cause memory disturbance in our case. The lesion in the left retrosplenial region may have contributed to the occurrence of defective route finding. The relation between defective route finding and the retrosplenial amnesia is discussed.

Aged↗
PubMed1997

[Cerebrovascular disorder and the language areas].

Recent progress of imaging techniques has achieved precise descriptions of aphasic syndromes associated with cerebrovascular disorders. Infarction of the left anterior cerebral artery brings about transcortical motor aphasia. Occlusion of each branches of the left middle cerebral artery produces characteristic language symptoms. Recently, cases with infarction of the areas of prefrontal and precentral arteries were reported to manifest fluent aphasia indistinguishable from the classical transcortical sensory aphasia. Rare cases with lesions restricted to the Broca's area (territory of the precentral artery) produces aphasia with normal fluency, word finding difficulty and deficit in sentence comprehension. Classical non-fluent Broca's aphasia is caused by infarctions which at least involves the areas of precentral and central arteries. Aphemia or pure word dumbness results from damages which involves territory of the central artery. Conduction aphasia is most often associated with lesions of the posterior parietal artery territory. As in the case of Broca's aphasia, Wernicke's aphasia is a composite of conduction aphasia, pure word deafness, transcortical sensory aphasia, and alexia with agraphia. The lesion of Wernicke's aphasia naturally involves the areas of all of these aphasic symptoms. Transcortical sensory aphasia is associated with lesions in the posteroinferior temporal region, and is often associated with watershed infarctions of the middle and posterior cerebral arteries. Aphasia which results from putaminal hemorrhage has ambiguous manifestation, and is difficult to be classified into Wernicke-Lichtheim's model. Assessment of its fluency is notoriously difficult. Thalamic aphasia is similar to either anomic aphasia or transcortical sensory aphasia. It was pointed out that classical aphasic syndromes are still valid as cerebral arterial occlusion syndromes, but are insufficient for the purpose of more precise anatomo-clinical correlation.

Aphasia↗
PubMed1997

[Visual agnosia induced by cerebrovascular disease].

Visual objects can be classified into some categories such as faces, landscapes, objects and letters. Visual agnosia specific to one of these categories can occur. This type of visual agnosia occurs at the occipitotemporal lobe lesion where the visual cognitive center exists, and is often induced by vascular disease of the posterior cerebral artery. In this study we categorized the symptoms of visual agnosia and presented the natures of these symptoms of patients, and then investigated the lesions responsible for the symptoms. In addition, we clarified the current most important issue for each symptom. Based on our results, we discussed the visual cognitive functions of the occipitotemporal lobe. The results indicate that visual cognitive dysfunction with respect to faces, landscapes, objects and letters corresponds to prosopagnosia, agnosia for streets, associative object agnosia and pure alexia, respectively. Investigation of the relationship between the symptoms of the above conditions and the responsible regions shows that the right medial-posterior region, right medial-anterior region, both lateral regions (left side is superior) and the left medial region are important in the visual cognition of faces, landscapes, objects and letters, respectively. Thus, it is speculated that the visual cognitive functions occur independently at different regions of the occipitotemporal lobe for each visual category.

Agnosia↗
PubMed2004

African American patients' perspectives on medical decision making.

BACKGROUND: The medical literature offers little information about how older African Americans view the medical decision-making process. We sought to describe the perspectives of older African American patients in a primary care clinic as they consider a medical decision. METHODS: We interviewed 25 African American patients older than 50 years who had discussed flexible sigmoidoscopy with their primary care provider. Interviews were analyzed using qualitative methods. RESULTS: Patients listed concerns about cancer and health, risks and benefits, their own understanding of the test, and the recommendation of the provider as the most important factors in their decision. Most patients wanted information about medical tests and procedures to increase their understanding and to provide reassurance rather than to guide decision making. Most patients explained that they wanted the provider to make medical decisions because of his or her training and experience. Despite this, many expressed a sense of ownership or control over one's own body. Patients thought trust was built by a health care provider's honesty, patience, kindness, interest, and continuity of care. CONCLUSIONS: Although traditional models of informed consent have emphasized providing patients with information to guide autonomous decision making, patients may want this information for other reasons. Fully informing patients about their medical condition increases understanding and provides reassurance. Because many of these patients want their provider to participate in making medical decisions, he or she should not only provide information but should also provide guidance to the patient.

Black or African American↗