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Journal of Neurosurgery. Case Lessons Mar 2022Remote cerebral infarction after combined revascularization of the middle cerebral artery (MCA) territory is rare in patients with moyamoya disease (MMD) with a...
Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case.
BACKGROUND
Remote cerebral infarction after combined revascularization of the middle cerebral artery (MCA) territory is rare in patients with moyamoya disease (MMD) with a fetal-type posterior communicating artery (PCoA).
OBSERVATIONS
A 57-year-old woman developed numbness in her right upper limb and transient motor weakness and was diagnosed with MMD. She also had a headache attack and a scintillating scotoma in the right visual field. Preoperative magnetic resonance angiography (MRA) showed stenosis of the left posterior cerebral artery (PCA). Combined revascularization was performed for the left MCA territory. No new neurological deficits were observed for 2 days after the operation, but right hemianopia, alexia, and agraphia appeared on postoperative day (POD) 4. Magnetic resonance imaging showed a new left occipitoparietal lobe infarction, and MRA showed occlusion of the distal left PCA. After that point, the alexia and agraphia gradually improved, but right hemianopia remained at the time of discharge on POD 18.
LESSONS
Cerebral ischemia in the PCA territory may occur after combined revascularization of the MCA territory in patients with fetal-type PCoA. For these cases, a double-barrel bypass or indirect revascularization to induce a slow conversion could be considered on its own as a treatment option.
PubMed: 36273866
DOI: 10.3171/CASE21704 -
Frontiers in Neurology 2023Chimeric antigen receptor T-cell therapy-related neurotoxicity is a novel cytokine-mediated neurological syndrome that may present with a broad spectrum of...
INTRODUCTION
Chimeric antigen receptor T-cell therapy-related neurotoxicity is a novel cytokine-mediated neurological syndrome that may present with a broad spectrum of manifestations. Descriptions of novel distinctive features are pivotal to untangling this condition's clinical and instrumental signature in order to inform diagnosis and pathophysiology.
CASE
A 27-year-old female patient received anti-CD19 CAR T cells for a refractory primary mediastinal B-cell lymphoma. At 6 days after the infusion, she developed mild ideo-motor slowing, dysgraphia, and drowsiness. Despite specific treatment with dexamethasone, her neurological status progressively worsened to a comatose state within 24 h. EEG and CSF analyses were non-specific, showing background slowing and inflammatory findings. Brain MRI revealed multiple focal punctate areas of T2-weighted hyperintensity localized in the body and isthmus of the corpus callosum. Following the administration of high-dose intravenous methylprednisolone, her neurological status resolved within 48 h. Notably, the follow-up brain MRI did not reveal any abnormalities in the corpus callosum, except for a reduction of fractional anisotropy.
CONCLUSION
Reversible punctate inflammatory foci of the body and isthmus of the corpus callosum may represent a novel radiological finding of CAR T-cell therapy-related neurotoxicity.
PubMed: 36824415
DOI: 10.3389/fneur.2023.1125121 -
International Journal of Environmental... Jan 2023Pure agraphias are caused by graphemic buffer damage. The graphemic buffer stores graphemic representations that handle the transition from spelling lexicon to writing...
Pure agraphias are caused by graphemic buffer damage. The graphemic buffer stores graphemic representations that handle the transition from spelling lexicon to writing or oral spellings. The authors report a case of a crossed pure agraphia, following the post-surgical removal of a right frontal low-grade glioma in a right-handed French patient. He presented a pure agraphia displaying the features of a graphemic buffer impairment. Our patient only made spelling errors, whereas repetition and other oral language abilities remained perfect. We found a greater number of errors for longer stimuli, increased errors for the medially located graphemes, and agraphia for both words and non-words and error types, essentially consisting of omissions, substitutions, and letter transpositions. We also observed no significant effect of word frequency on spelling errors, but word length affected the rate of errors. The particularity of this case was linked to right frontal subcortical injuries in a right-handed subject. To our knowledge, it is the first report of a crossed pure agraphia caused by graphemic buffer impairment. Further studies are needed in order to analyse the role of subcortical structures, particularly the caudate nucleus in the graphemic buffer during writing tasks, as well as the participation of the non-dominant hemisphere in writing language.
Topics: Male; Humans; Agraphia; Language; Writing; Neuropsychological Tests
PubMed: 36674102
DOI: 10.3390/ijerph20021346 -
Neurological Sciences : Official... Jun 2021
Topics: Agraphia; Alexia, Pure; Brain Ischemia; COVID-19; Humans; Ischemic Stroke; SARS-CoV-2; Stroke
PubMed: 33768435
DOI: 10.1007/s10072-021-05211-4 -
Children (Basel, Switzerland) Jun 2022Specific Learning Disorders (SLD) are a group of heterogeneous health deficits frequently diagnosed in early childhood that cause difficulties in general intellectual...
UNLABELLED
Specific Learning Disorders (SLD) are a group of heterogeneous health deficits frequently diagnosed in early childhood that cause difficulties in general intellectual functioning. In the last decades in Italy new laws have been developed to give practical guidelines for the best education plans for children with SLD.
BACKGROUND
The aim of our study was to determine the efficacy of the educational treatment on SLD in Primary and Secondary schools in the Italian city of Barletta. We acquired valuable data to evaluate Special Education Needs during COVID-19.
METHODS
Our study was conducted from April to June 2021, during the second "lockdown" period in Italy. A fact-finding survey was conducted to schools with a questionnaire provided to the teachers to acquire data on the SEN applied in the management of distance learning for children.
RESULTS
The study involved 15 male and 6 female pupils with SLD in Primary Schools and 18 male and 6 female in Secondary Schools. The schools participating in the study organized distance learning programs with a support teacher with a 1:1 ratio. Data showed that all children with SLD needed a support teacher.
CONCLUSIONS
The findings of this pilot study suggest that distance learning programs are able to achieve adequate educational goals, despite the difficulties of the lockdown period.
PubMed: 35740762
DOI: 10.3390/children9060825 -
Acta Neurologica Belgica Oct 2023
Topics: Male; Humans; Aged; Alexia, Pure; COVID-19; Stroke; Agraphia
PubMed: 35750954
DOI: 10.1007/s13760-022-02014-y -
Cureus Feb 2021We report a case of a 48-year-old man with a history of episodes of severe headache, accompanied by motor aphasia and agraphia, with complete recovery between episodes....
We report a case of a 48-year-old man with a history of episodes of severe headache, accompanied by motor aphasia and agraphia, with complete recovery between episodes. The neurological examination revealed no abnormality. A lumbar puncture was performed and showed lymphocytic pleocytosis. Cerebrospinal fluid analysis ruled out viral, bacterial, mycobacterial, fungal, treponemal, and NMDA receptor antibodies. Brain magnetic resonance imaging and electroencephalogram revealed no abnormalities. A focal frontotemporal area of hypoperfusion was detected in brain single-photon emission tomography. A diagnosis of syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) was made to the patient and then treated with ibuprofen 400 mg three times per day with excellent response. He remained asymptomatic and free of any relapse during six months of following. We presented a typical case of HaNDL that manifests with agraphia, a transient focal neurological deficit non previously reported. Showing that the clinical picture could probably be any sign and symptom related to focal cortical alteration due to cortical transient hypoperfusion.
PubMed: 33717723
DOI: 10.7759/cureus.13178 -
Journal of Ayurveda and Integrative... 2023Domestically, gas geysers are used in developing countries like India to supply hot water in bathrooms. These are of low economic value, with no requirement of...
Domestically, gas geysers are used in developing countries like India to supply hot water in bathrooms. These are of low economic value, with no requirement of electricity and easy installation, hence they are high in demand. A female patient of 14 year visited to a private Ayurved clinic on 27/12/2021 with complaints of difficulty in dysgraphia, dyslexia, dysphonia and fall (sometimes) while walking on uneven and unknown pathway. Four years ago, the patient landed into a vegetative state and was bed ridden, her condition was further diagnosed as Gas Geyser Syndrome. Here an effort has been put forth to reveal the concept of ayurvedic management adopted in a survivor of Gas Geyser Syndrome which is found to be effective. In Ayurveda the symptoms of Acute Gas Geyser syndrome can be correlated with Visha (Toxins) and its vishalakshana (Toxicity symptoms) wherein Murcha (Unconsciousness) and Sanyasa (Stage of Coma) are seen. The long term side effects of Gas Geyser Syndrome can be correlated with Vatavyadhi (Neurological disorders) as the stages of the disease manifestation presents with more neurological deficits. Ayurvedic intervention with internal medications along with the panchakarma procedures in the treatment of Gas geyser syndrome exhibits encouraging results which were seen in improving her cognition, memory and essential skills like writing, verbal communication, thinking skills, use of technology in socializing with the community.
PubMed: 37271063
DOI: 10.1016/j.jaim.2023.100713 -
Frontiers in Human Neuroscience 2022Phonological impairment contributes to deficits in repetition and spoken naming in logopenic variant Primary Progressive Aphasia (lvPPA), but weakened phonology can also...
Phonological impairment contributes to deficits in repetition and spoken naming in logopenic variant Primary Progressive Aphasia (lvPPA), but weakened phonology can also affect written language skills. In this experimental case report, we demonstrate phonological text agraphia in a 71-year-old woman in the early stages of lvPPA that undermined her ability to write meaningful, grammatical sentences. We investigated the therapeutic value of a rigorous treatment protocol to strengthen phonological manipulation skills coupled with transcranial direct current stimulation (tDCS). Intervention took place 5 days a week for 2 weeks with active tDCS, followed by a 2-month rest period, and then a second period of phonological treatment with sham tDCS. Over the course of treatment, our participant demonstrated improved phonological transcoding and manipulation skills as well as marked improvement in the proportion of grammatically well-formed, meaningful written narratives. Improvements in spelling and letter selection were also observed. Treatment gains were documented during phonological intervention in both active tDCS and sham treatment phases and were maintained 2 months after the conclusion of intervention. Importantly, improvements were observed in the context of a progressive disorder. These data present compelling evidence regarding the impairment-based approach that targets compromised phonological skills, presenting opportunity for improving functional written communication skills relevant to the everyday lives of individuals with lvPPA.
PubMed: 36760227
DOI: 10.3389/fnhum.2022.1006350 -
Neurological Sciences : Official... Dec 2020COVID-19 following infection by SARS-CoV-2 can affect the brain causing confusion, depression, and dementia-like signs. Nonetheless, the presence of more specific...
COVID-19 following infection by SARS-CoV-2 can affect the brain causing confusion, depression, and dementia-like signs. Nonetheless, the presence of more specific neuropsychological signs because of COVID-19 remains unexplored. We report on LA, a patient who was affected by a left-hemisphere ischemic stroke, probably because of SARS-CoV-2. The patient showed a highly specific neuropsychological profile characterized by severe agraphia and some signs of conduction aphasia. All other cognitive and sensorimotor functions remained intact. We sustain that specific neuropsychological signs can be observed in patients with COVID-19. Therefore, in-depth and comprehensive neuropsychological assessment should be included to better explore and qualify the neuropsychological consequences of COVID-19. This is a new challenge for diagnosis and rehabilitation, with important consequences for the involved neuropsychological services.
Topics: Agraphia; Aphasia, Conduction; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral; SARS-CoV-2; Stroke
PubMed: 32989587
DOI: 10.1007/s10072-020-04768-w