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Frontiers in Neurology 2023Functional restoration of hemiplegic upper limbs is a difficult area in the field of neurological rehabilitation. Electrical stimulation is one of the treatments that...
BACKGROUND
Functional restoration of hemiplegic upper limbs is a difficult area in the field of neurological rehabilitation. Electrical stimulation is one of the treatments that has shown promising advancements and functional improvements. Most of the electrical stimulations used in clinical practice are surface stimulations. In this case, we aimed to investigate the feasibility of a minimally invasive, ultrasound-guided median nerve electrical stimulation (UG-MNES) in improving the upper limb motor function and activity of a patient with right-sided hemiparesis.
CASE PRESENTATION
A 65-year-old male recovering from a left massive intracerebral hemorrhage after open debridement hematoma removal had impaired right limb movement, right hemianesthesia, motor aphasia, dysphagia, and complete dependence on his daily living ability. After receiving 3 months of conventional rehabilitation therapy, his cognitive, speech, and swallowing significantly improved but the Brunnstrom Motor Staging (BMS) of his right upper limb and hand was at stage I-I. UG-MNES was applied on the right upper limb for four sessions, once per week, together with conventional rehabilitation. Immediate improvement in the upper limb function was observed after the first treatment. To determine the effect of UG-MNES on long-term functional recovery, assessments were conducted a week after the second and fourth intervention sessions, and motor function recovery was observed after 4-week of rehabilitation. After completing the full rehabilitation course, his BMS was at stage V-IV, the completion time of Jebsen Hand Function Test (JHFT) was shortened, and the scores of Fugl-Meyer Assessment for upper extremity (FMA-UE) and Modified Barthel Index (MBI) were increased. Overall, the motor function of the hemiplegic upper limb had significantly improved, and the right hand was the utility hand. Electromyography (EMG) and nerve conduction velocity (NCV) tests were normal before and after treatment.
CONCLUSION
The minimally invasive, UG-MNES could be a new alternative treatment in stroke rehabilitation for functional recovery of the upper limbs.
PubMed: 38046582
DOI: 10.3389/fneur.2023.1244192 -
Cortex; a Journal Devoted To the Study... May 2024Patients who have a yes-no reversal respond "yes" when they mean no and vice versa. The unintentional response can be made both verbally and with gestures (e.g., head...
Patients who have a yes-no reversal respond "yes" when they mean no and vice versa. The unintentional response can be made both verbally and with gestures (e.g., head shake or nod, thumbs up or down). Preliminary reports associate this phenomenon with 4-repeat tauopathies including primary progressive apraxia of speech (PPAOS), nonfluent/agrammatic primary progressive aphasia, and corticobasal syndrome; however, the significance and timing of this symptom relative to others are not well understood. Whereas some accounts associate yes-no reversals with other binary reversals (e.g., up/down, hot/cold) and attribute the reversals to disturbances of selection within the language system, others implicate more general inhibitory control processes. Here, we compared clinical and neuroimaging findings across 30 patients with PPAOS (apraxia of speech in the absence of aphasia), 15 of whom had a yes-no reversal complaint and 15 who did not. The two groups did not differ on any of the language or motor speech measures; however, patients who had the yes-no reversal received lower scores on the Frontal Assessment Battery and motor assessments. They also had greater hypometabolism in the left supplementary motor area and bilateral caudate nuclei on [F]-fluorodeoxyglucose PET, but only the right caudate nucleus cluster survived correction for multiple comparisons. We interpret these results to suggest that the yes-no reversal phenomenon is associated with cognitive abilities that are supported by the frontostriatal network; more specifically, impaired response inhibition.
PubMed: 38833818
DOI: 10.1016/j.cortex.2024.04.008 -
Cureus Feb 2024Meningitis is a rare but possible complication of sinusitis. We present a case of a 21-year-old woman with a history of fever, headache and nasal obstruction who...
Meningitis is a rare but possible complication of sinusitis. We present a case of a 21-year-old woman with a history of fever, headache and nasal obstruction who presented at the emergency department with psychomotor agitation. Orotracheal intubation and invasive mechanical ventilation were given to protect airway. Blood analysis showed leukocytosis and elevated C-reactive protein. Cerebral and maxillofacial computed tomography (CT) demonstrated pansinusitis with gas foci more prominent in the left frontal sinus with an area of bone rarefaction on the posterior wall with possible communication with the cranial cavity. Lumbar puncture was performed. Empirical antibiotic and corticosteroid therapy were started. Neurosurgery (NC) and Ear Nose and Throat (ENT) surgeons declined indication for urgent surgery and she was admitted at General ICU. On the fourth day of hospitalization, a brain magnetic resonance imaging (CE-MRI) was performed, revealing subdural empyema and cerebritis adjacent to the frontal sinus. She was transferred to the reference neurosurgical center for surgical interventions and was admitted post-operatively at the Neurocritical Care Unit (NCCU). Reevaluation MRI showed residual anterior frontal empyema and absence of focus control in peri-nasal sinusitis, requiring a new ENT surgery. A spp was isolated from the blood, from the pus collected from the sinuses, and the CSF was sterile. The patient completed 21 days of antibiotic therapy. She was extubated on the 19th day, with Broca's aphasia and right hemiparesis, and on the 23rd day transferred to the ENT Service and later to the Rehabilitation Service. We present a case of atypical central nervous system (CNS) infection by a rare agent, highlighting the importance of vigilance, focus control, and neurocritical care. In a severe and complex manifestation like this, the management typically involves medical and surgical interventions. Subdural empyema should be treated as a neurosurgical emergency due to the potential rapid deterioration in patient's neurological condition, attributed to secondary damage. In this case, brain multimodal monitoring, was very helpful in acute phase management. Neurocritical care teams should be involved early in patients with this presentation of CNS infection to provide optimal management, reducing complications and secondary brain lesions therefore improving patient outcomes.
PubMed: 38533169
DOI: 10.7759/cureus.54864 -
Clinical Neurology and Neurosurgery Dec 2023A resting-state functional magnetic resonance imaging (rs-fMRI) approach was used to explore functional connectivity (FC) in language and non-language brain networks in...
OBJECTIVE
A resting-state functional magnetic resonance imaging (rs-fMRI) approach was used to explore functional connectivity (FC) in language and non-language brain networks in acute post-stroke aphasia (PSA) patients, with a specific focus on the relationship between these fMRI results and patient clinical presentation.
METHODS
In total, 20 acute PSA patients and 30 age-, sex-, and education level-matched healthy control (HC) participants were recruited and subjected to rs-fMRI imaging. In addition, western aphasia battery analyses(WAB) were used to compute aphasia quotient (AQ) values for PSA patients. Granger causality was employed to examine connections among cognition-associated resting-state brain networks, and the right middle frontal gyrus (RMFG),the mirror brain regions of Broca's area and the Wernicke's area, the right superior temporal gyrus were selected as regions of interest (ROIs). The REST plus software was then used to perform FC analyses of these regions to analyze changes in FC related to PSA pathogenesis.
RESULTS
Relative to HC individuals, PSA patients exhibited significantly higher levels of intra-network FC between the right middle frontal gyrus (RMFG) and the left middle occipital gyrus (LMOG), with such FC being positively correlated with the AQ scores (P = 0.018). Moreover, reduced FC was detected between the Broca's area homolog and the left middle frontal gyrus (LMFG), while FC was enhanced between the Wernicke's area homolog and cerebellar vermis, and this FC was similarly positively correlated with patient AQ scores (P = 0.0297).
CONCLUSION
These results suggest that FC between the bilateral hemispheres of the brain is significantly disrupted in acute PSA patients, interfering with the normal non-specific language network. Aphasia severity was further found to correlate with FC among many of the analyzed regions of the brain.
Topics: Humans; Brain Mapping; Brain; Aphasia; Language; Magnetic Resonance Imaging; Broca Area
PubMed: 37951030
DOI: 10.1016/j.clineuro.2023.108044 -
Clinical Linguistics & Phonetics Dec 2023This study used the categorical perception (CP) paradigm, a fine-grained perceptual method, to investigate the perceptual performance of lexical tones in Chinese people...
This study used the categorical perception (CP) paradigm, a fine-grained perceptual method, to investigate the perceptual performance of lexical tones in Chinese people with post-stroke aphasia (PWA). Twenty patients with post-stroke aphasia (10 Broca's and 10 Wernicke's) and ten neurologically intact age-matched control participants were recruited to complete both identification and discrimination tasks of the Mandarin Tone 1-2 continuum. In addition, all participants completed tests on their auditory comprehension ability and working memory. The results showed that both Broca's and Wernicke's patients exhibited reduced sensitivity to within-category and between-category information but preserved CP of lexical tones. The degree of CP of lexical tones related to working memory in aphasic patients. Furthermore, lower-level acoustic processing underpinned higher-level phonological processing on the CP of lexical tones since both patient groups' unbalanced pitch processing ability extended to their CP of lexical tones. These findings are significant for researchers and clinicians in speech-language rehabilitation, clinical psychology, and cognitive communication.
Topics: Humans; Aphasia; Language; Linguistics; Perception; Speech Perception; Pitch Perception
PubMed: 36373592
DOI: 10.1080/02699206.2022.2138785 -
Verb Tense Production in People With Nonfluent Aphasia Across Different Discourse Elicitation Tasks.American Journal of Speech-language... May 2024Verb tense production is known to be impaired in people with nonfluent aphasia. Selective past tense impairment in this population has been reported, but results are...
PURPOSE
Verb tense production is known to be impaired in people with nonfluent aphasia. Selective past tense impairment in this population has been reported, but results are inconsistent and lacking at the discourse level. In addition, language production can be affected by discourse elicitation tasks depending on the cognitive linguistic demands and instructions unique to each task. There is limited evidence regarding whether verb tense production in people with nonfluent aphasia is impacted by discourse task demands. Understanding this potential impact is important for clinicians and researchers who are interested in assessing and then identifying effective clinical goals for this population. Therefore, this study aimed to investigate the trends of verb tense production across various discourse elicitation tasks in people with nonfluent aphasia compared to people without aphasia.
METHOD
Language samples for 23 people with nonfluent aphasia and 27 people without aphasia were obtained for six discourse tasks from the AphasiaBank database. We calculated ratios of past tense, present tense, future tense, imperative, and unknown verb types to compare which tense was used most frequently within and across the tasks and groups.
RESULTS AND CONCLUSIONS
Our findings revealed evidence of verb tense production deficits and a selective past tense impairment in people with nonfluent aphasia. Discourse task effects were shown for people without aphasia but were scarce in people with nonfluent aphasia. This finding could be explained by an overall reduction of verb production and overreliance on present tense production in nonfluent aphasia. These results suggest the potential methodological implications of using different discourse tasks to evaluate verb tense production in people with nonfluent aphasia. Future studies need to evaluate discourse task effects on other aspects of verb production (e.g., moods) and specific task factors (e.g., presence or absence of visual stimulus).
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.25146242.
Topics: Humans; Male; Female; Middle Aged; Aged; Aphasia, Broca; Speech Production Measurement; Case-Control Studies; Semantics; Aged, 80 and over; Adult; Linguistics; Language Tests
PubMed: 38324346
DOI: 10.1044/2024_AJSLP-23-00165 -
Journal of Neuroimmunology Oct 2023Neurological involvement in sarcoidosis is termed as neurosarcoidosis. It usually leads to cranial neuropathies, although it can involve any part of the neuroaxis....
Neurological involvement in sarcoidosis is termed as neurosarcoidosis. It usually leads to cranial neuropathies, although it can involve any part of the neuroaxis. Although sarcoidosis is a proinflammatory state, there is an associated anergic state demonstrable by a feeble tuberculin response. Lymphocytic sequestration in granulomas can be associated with peripheral CD4 lymphocytopenia (40% of patients with sarcoidosis) predisposing to opportunistic infections. Here we have described a young, otherwise immunocompetent male presenting with subacute onset right hemiparesis with motor aphasia, who was diagnosed to have progressive multifocal leukoencephalopathy (PML) secondary to pulmonary sarcoidosis. We want to emphasize that PML should be considered as a differential in all cases of secondary demyelination (even apparently immunocompetent individuals) as early diagnosis and treatment of the underlying cause is likely to yield better outcomes.
Topics: Humans; Male; Adult; Leukoencephalopathy, Progressive Multifocal; Sarcoidosis; Lymphopenia; Opportunistic Infections; Leukopenia; JC Virus
PubMed: 37734315
DOI: 10.1016/j.jneuroim.2023.578201 -
Neurology. Genetics Apr 2024Pathogenic variants in are associated with a spectrum of epilepsy-aphasia syndromes (EASs). Seizures as well as speech and language disorders occur frequently but vary...
BACKGROUND AND OBJECTIVES
Pathogenic variants in are associated with a spectrum of epilepsy-aphasia syndromes (EASs). Seizures as well as speech and language disorders occur frequently but vary widely in severity, both between individuals and across the life span. The link between this phenotypic spectrum and brain characteristics is unknown. Specifically, altered brain networks at the root of speech and language deficits remain to be identified. Patients with pathogenic variants in offer an opportunity to interrogate the impact of glutamate receptor dysfunction on brain development.
METHODS
We characterized brain anomalies in individuals with pathogenic variants and EASs, hypothesizing alterations in perisylvian speech-language regions and the striatum. We compared structural MRI data from 10 individuals (3 children and 7 adults, 3 female) with pathogenic variants with data from age-matched controls (N = 51 and N = 203 in a secondary analysis). We examined cortical thickness and volume in 4 a priori hypothesized speech and language regions (inferior frontal, precentral, supramarginal, and superior temporal) and across the whole brain. Subcortical structures (hippocampus, basal ganglia, thalamus) and the corpus callosum were also compared.
RESULTS
Individuals with pathogenic variants showed increased thickness and volume in the posterior part of Broca's area (inferior frontal gyrus, pars opercularis). For thickness, the effects were bilateral but more pronounced in the left (large effect size, η = 0.37) than the right (η = 0.12) hemisphere. Both volume and thickness were also higher in the bilateral superior temporal region while the supramarginal region showed increased thickness only. Whole-brain analyses confirmed left-sided thickness increases in Broca's area, with additional increases in the occipital and superior frontal cortices bilaterally. Hippocampal volume was reduced in the left hemisphere. There were no age-dependent effects or corpus callosum group differences.
DISCUSSION
Anomalies in perisylvian regions, with largest differences in Broca's area, suggest an altered development of classical speech-language networks in -related EAS. Left hippocampal reduction suggests a role for this structure in early speech and language development and is consistent with gene expression in that region. Overall, elucidating the neural correlates of EAS provides insights into the impact of dysfunction, opening avenues for targeted intervention in developmental syndromes with compromised speech-language development.
PubMed: 38715655
DOI: 10.1212/NXG.0000000000200129 -
Frontiers in Neurology 2023Loss of time is a major obstacle to efficient stroke treatment. Our telestroke path intends to optimize prehospital triage using a video link connecting ambulance...
Real-time video analysis allows the identification of large vessel occlusion in patients with suspected stroke: feasibility trial of a "telestroke" pathway in Northwestern Switzerland.
BACKGROUND AND AIM
Loss of time is a major obstacle to efficient stroke treatment. Our telestroke path intends to optimize prehospital triage using a video link connecting ambulance personnel and a stroke physician. The objectives were as follows: (1) To identify patients suffering a stroke and (2) in particular large vessel occlusion (LVO) strokes as candidates for endovascular treatment. We have chosen the Rapid Arterial Occlusion Evaluation (RACE) scale for this purpose.
METHODS
This analysis aimed to verify the feasibility of prehospital stroke identification by video assessment. In this prospective telestroke cohort study, we included 97 subjects, in which the RACE score (items: facial palsy, arm and leg motor function, head and gaze deviation, and aphasia or agnosia) was applied, and the assessment videotaped by a trained member of the Emergency Medical Services (EMS) in the field using a mobile device. Each recorded patient video was independently assessed by three experienced stroke physicians from a certified stroke center and compared to the neuroimaging gold standard. Within this feasibility study, the stroke code was not altered by the outcome of the RACE assessment, and all patients underwent the standard procedures within the emergency unit.
RESULTS
We analyzed 97 patients (median age 78 years, 53% women), of whom 51 (52.6%) suffered an acute stroke, 12 (23.5%) of which were due to an LVO and 46 patients had symptoms mimicking a stroke. The sensitivity of stroke identification was 77.8%, and specificity was 53.6%. In regard to the identification of an LVO, sensitivity was 69.4% and specificity was 84.3%. The inter-rater agreement in the RACE-score assessment was ICC = 0.82 (intraclass-correlation coefficient).
CONCLUSION
These results confirm our hypothesis that the local telestroke concept is feasible. It allows correct (i) stroke and (ii) LVO identification in the majority of the cases and thus has the potential to assist in efficient prehospital triage.
PubMed: 37941577
DOI: 10.3389/fneur.2023.1232401 -
Applied Neuropsychology. Adult Jan 2024Approximately 50% of patients with amyotrophic lateral sclerosis (ALS) experience cognitive decline, with frontotemporal dementia (FTD) accounting for up to 15% of these...
OBJECTIVE
Approximately 50% of patients with amyotrophic lateral sclerosis (ALS) experience cognitive decline, with frontotemporal dementia (FTD) accounting for up to 15% of these cases. Despite this, there is considerable delay in diagnosis, which affects patient care.
METHODS
We report longitudinal results of neuropsychological evaluations in a patient diagnosed with non-fluent/agrammatic primary progressive aphasia (nfvPPA) and amyotrophic lateral sclerosis (ALS). The patient, Ms. X, presented with progressive speech difficulties starting in her late-60's. Initial diagnosis was nfvPPA. After 4-5 years of progressive swallowing difficulties, as well as facial weakness, her diagnosis was modified to PPA-ALS.
RESULTS
Ms. X underwent neuropsychological evaluations three times over a period of five years. Results of evaluations were intact and stable over time, except for progressive loss of speech impacting her performance on a sentence repetition task.
CONCLUSION
This case study provides valuable insight into the overlap between PPA-ALS from a neuropsychological standpoint. The results reflect preserved cognitive skills in the context of loss of speech and motor abilities. This case study also shows the length of time between onset of symptoms and clear diagnosis, which often requires an immense amount of health literacy and personal advocacy on the part of the patient.
PubMed: 38241787
DOI: 10.1080/23279095.2024.2302833