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Brain Sciences Jun 2024Post-stroke cognitive impairment is a common and disabling condition with few effective therapeutic options. After stroke, neural reorganization and other neuroplastic... (Review)
Review
Post-stroke cognitive impairment is a common and disabling condition with few effective therapeutic options. After stroke, neural reorganization and other neuroplastic processes occur in response to ischemic injury, which can result in clinical improvement through spontaneous recovery. Neuromodulation through transcranial direct current stimulation (tDCS) is a promising intervention to augment underlying neuroplasticity in order to improve cognitive function. This form of neuromodulation leverages mechanisms of neuroplasticity post-stroke to optimize neural reorganization and improve function. In this review, we summarize the current state of cognitive neurorehabilitation post-stroke, the practical features of tDCS, its uses in stroke-related cognitive impairment across cognitive domains, and special considerations for the use of tDCS in the post-stroke patient population.
PubMed: 38928614
DOI: 10.3390/brainsci14060614 -
Biomedicines Jun 2024The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS... (Review)
Review
The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS on both motor and other symptoms in stroke rehabilitation, its impact on functional ability, and potential side effects (PROSPERO number: CRD42022365697). A systematic electronic database search was performed by using PubMed Central (PMC), EMBASE, and Web of Science, with a cutoff date of November 2023. Data extracted included study details, NIBS methodology, outcome measures, and results. The risk of bias in eligible studies was also assessed. Twenty-two clinical studies involving 1016 participants were finally included, with a focus on outcomes related to post-stroke motor recovery (gait and balance, muscle spasticity, and upper limb dexterity) and other functions (dysphagia and aphasia). Positive effects were observed, especially on motor functions like gait and balance. Some efficiency was also observed in dysphagia rehabilitation. However, findings on language recovery were preliminary and inconsistent. A slight improvement in functional ability was noted, with no serious adverse effects reported. Further studies are needed to explore the effects of cerebellar NIBS on post-stroke non-motor deficits and to understand how cerebellar engagement can facilitate more precise treatment strategies for stroke rehabilitation.
PubMed: 38927555
DOI: 10.3390/biomedicines12061348 -
Cureus May 2024Stroke is the most common cause of death and disability in the world, and ischemic etiology plays a major role. Atrial septal aneurysm (ASA) is a localized saccular...
Stroke is the most common cause of death and disability in the world, and ischemic etiology plays a major role. Atrial septal aneurysm (ASA) is a localized saccular deformity of the atrial septum, associated with ischemic stroke independently or in association with other atrial septal defects (ASD). There is a higher incidence of stroke in the population with ASD. In these patients, the presence of ASA is an important predictor of recurrent stroke. This is a case of ischemic stroke in a 44-year-old who presented with sudden-onset right-sided body weakness, expressive aphasia, and non-specific confusion for one hour, with an initial National Institutes of Health Stroke Scale (NIHSS) score of 7. CT angiogram revealed occlusion of the M3 branch of the left middle cerebral artery in the left lateral frontal lobe. Code stroke was called, and the patient was given tenecteplase (TNK), after which her right-side weakness and aphasia resolved. Trans-thoracic echo with bubble study showed ASA with positive bubble study. Lone ASA or ASA with concomitant ASD poses a higher risk of recurrent stroke in younger patients, especially those without significant risk factors for strokes. Patients with ASA and concomitant ASD are at high risk for recurrent ischemic stroke and should be kept under surveillance with continued medical therapy. We present a case of ischemic stroke caused by ASA and a review of the current literature and case reports documenting cases with similar presentations.
PubMed: 38915999
DOI: 10.7759/cureus.60955 -
Cureus May 2024Central neurocytoma (CN) is a rare, low-grade, neuronal tumor frequently encountered in young adults. Complete surgical resection is the treatment of choice; however, it...
Central neurocytoma (CN) is a rare, low-grade, neuronal tumor frequently encountered in young adults. Complete surgical resection is the treatment of choice; however, it is associated with grave postoperative complications in a quarter of patients, including neurological (motor weakness, memory deficit, aphasia, and seizure) as well as regional (hydrocephalus, hematoma, infection, and subcutaneous hydrops) complications. Herein, we present a case of a 35-year-old female who presented with decreased vision for the last 7-8 days and headache over the last 1-1.5 years. An ophthalmologic examination suggested papilledema. Magnetic resonance imaging (MRI) of the brain illustrated a well-circumscribed, large, lobulated, altered signal intensity midline intraventricular lesion (72 × 68 mm) attached to the septum pellucidum near the foramen of Monro (FoM) most likely to be CN. The patient underwent complete surgical resection but required re-exploration the next day for hematoma removal due to intraventricular hemorrhage. Over the next 40 days, the patient developed hydrocephalus with transtentorial herniation and succumbed. Histopathological examination (HPE) was suggestive of CN and immunohistochemistry (IHC) was strongly positive for synaptophysin, thus confirming the diagnosis of CN.
PubMed: 38915980
DOI: 10.7759/cureus.60969 -
Iranian Journal of Public Health May 2024Compared with able-bodied people, speech disabilities are more prone to various mental health problems. We aimed to explore the impact of positive psychology-based...
BACKGROUND
Compared with able-bodied people, speech disabilities are more prone to various mental health problems. We aimed to explore the impact of positive psychology-based intervention strategies on emotional cognition, mental health, and recovery of speech function in speech disabilities.
METHODS
In May 2023, 306 cases of speech disabilities were selected from 112 village committees and 129 neighborhood committees in Jingmen City, China. The control group was given routine speech rehabilitation training, and the observation group was given an intervention strategies-based on positive psychology based on the above training. The Symptom Checklist-90 (SCL-90), Chinese Facial Emotion Test (CFET), Comprehensive Function Assessment for Disabled Children (CFADC), and Boston Diagnostic Aphasia Examination (BDAE) were used to evaluate the two groups of patients before and after intervention.
RESULTS
After the intervention, the mental state scores (psychotic, obsessive-compulsive symptoms, somatization, paranoia, terror, hostility, anxiety, and depression) of the observation group were lower than those of the control group (<0.05). The correct emotional scores in the observation group were higher than those in the control group were. However, the remote error scores of the observation group were lower than those of the control group were. The difference was also statistically significant (<0.05). The cognitive function score, speech function score, and BDAE score (retelling, writing, fluency, and reading comprehension) of the observation group were all higher than those of the control group (<0.05).
CONCLUSION
The intervention strategies-based on positive psychology could promote the improvement of health problems and speech function in speech disabilities.
PubMed: 38912140
DOI: 10.18502/ijph.v53i5.15588 -
ENeurologicalSci Jun 2024Some patients with primary progressive aphasia (PPA) demonstrate only anomia. The lack of longitudinal observations of anomic PPA precluded us from determining whether...
Some patients with primary progressive aphasia (PPA) demonstrate only anomia. The lack of longitudinal observations of anomic PPA precluded us from determining whether progressive anomic aphasia was simply an early stage of semantic or logopenic variants, or a relatively independent variant. Herein, we report the 10-year clinical course of a patient with PPA who presented with pure anomic aphasia for 9 years. He is a right-handed man with anomia, who noticed word-finding difficulty at age 73. He was admitted to the hospital at age 77. On admission, the patient showed pure anomic aphasia with preserved other language function. Episodic memory and visuospatial function were preserved. Magnetic resonance imaging (MRI) revealed left temporal lobe atrophy. At 82 years of age, the patient presented with pure anomic aphasia. At 83 years old, he showed mild impairment in word comprehension and semantic memory, in addition to anomia. MRI demonstrated further atrophy in the bilateral anterior temporal lobes, predominantly on the left side. This case suggests the possibility of slowly progressive, late-onset anomic PPA, which could be differentiated from the early stage of semantic or logopenic variants.
PubMed: 38911510
DOI: 10.1016/j.ensci.2024.100508 -
Neurobiology of Language (Cambridge,... 2024Hearing one's own speech allows for acoustic self-monitoring in real time. Left-hemisphere motor planning regions are thought to give rise to efferent predictions that...
Hearing one's own speech allows for acoustic self-monitoring in real time. Left-hemisphere motor planning regions are thought to give rise to efferent predictions that can be compared to true feedback in sensory cortices, resulting in neural suppression commensurate with the degree of overlap between predicted and actual sensations. Sensory prediction errors thus serve as a possible mechanism of detection of deviant speech sounds, which can then feed back into corrective action, allowing for online control of speech acoustics. The goal of this study was to assess the integrity of this detection-correction circuit in persons with aphasia (PWA) whose left-hemisphere lesions may limit their ability to control variability in speech output. We recorded magnetoencephalography (MEG) while 15 PWA and age-matched controls spoke monosyllabic words and listened to playback of their utterances. From this, we measured speaking-induced suppression of the M100 neural response and related it to lesion profiles and speech behavior. Both speaking-induced suppression and cortical sensitivity to deviance were preserved at the group level in PWA. PWA with more spared tissue in pars opercularis had greater left-hemisphere neural suppression and greater behavioral correction of acoustically deviant pronunciations, whereas sparing of superior temporal gyrus was not related to neural suppression or acoustic behavior. In turn, PWA who made greater corrections had fewer overt speech errors in the MEG task. Thus, the motor planning regions that generate the efferent prediction are integral to performing corrections when that prediction is violated.
PubMed: 38911464
DOI: 10.1162/nol_a_00139 -
Cureus May 2024Immune effector cell-associated neurotoxicity syndrome (ICANS) is a well-known side effect of chimeric antigen receptor (CAR) T-cell therapy but has occasionally been...
Glofitamab-Associated Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Presenting as Serial Seizures and Responding Positively to Antiseizure Drugs and Anakinra: A Case Report.
Immune effector cell-associated neurotoxicity syndrome (ICANS) is a well-known side effect of chimeric antigen receptor (CAR) T-cell therapy but has occasionally been described with immune checkpoint inhibitors as well. Glofitamab-associated ICANS with a bispecific monoclonal antibody has rarely been reported. The patient is a 63-year-old male with a history of mantle cell lymphoma, diagnosed at age 37, and aggressive large-cell B-cell lymphoma, diagnosed at age 50. Despite adequate chemotherapy, immunotherapy, autologous stem cell transplantation, and CAR T-cell therapy, there were several relapses, including meningeal carcinomatosis at age 61 and intracerebral lymphoma at age 62. For this reason, glofitamab was started. One week after the ninth cycle, the patient developed drowsiness, behavioral changes, word-finding difficulties, aphasia, focal to bilateral tonic-clonic seizures, and focal onset seizures, which resolved after 16 days with levetiracetam, valproic acid, lorazepam, and midazolam. Since there was no infectious disease, electrolyte disturbance, metabolic disorder, cardiovascular disease, or relapse of lymphoma, glofitamab-associated ICANS was suspected, and anakinra was administered. The case shows that ICANS with drowsiness, behavioral changes, aphasia, and seizures can develop with glofitamab and that patients with structural brain abnormalities may be prone to this.
PubMed: 38910651
DOI: 10.7759/cureus.60833 -
Journal of Radiology Case Reports 2024Traumatic intracranial ICA dissections are not commonly seen in children. Dissection resulting in perfusion deficit warrants intervention. Here we encountered a patient...
BACKGROUND
Traumatic intracranial ICA dissections are not commonly seen in children. Dissection resulting in perfusion deficit warrants intervention. Here we encountered a patient who experienced traumatic ICA dissection, treated by endovascular stenting.
METHODS
A 10-year-old female presented with aphasia and right sided weakness following trauma. Imaging showed deficit in the left MCA territory without core. Further imaging showed dissection of the left supraclinoid ICA, confirmed by digital subtraction angiography.
RESULTS
A Neuroform Atlas stent was placed without complication. All dysarthria and weakness had resolved on follow-up 5 months post-stenting.
CONCLUSIONS
Acute stroke symptoms in children can result in lasting deficits if not treated quickly. Medical management is regarded to be first line, depending on presentation. Endovascular stenting may provide a promising means to treat pediatric ICA dissections involving perfusion deficits and mitigate permanent ischemic changes.
Topics: Humans; Female; Stents; Child; Carotid Artery, Internal, Dissection; Endovascular Procedures; Angiography, Digital Subtraction; Cerebral Infarction; Reperfusion
PubMed: 38910586
DOI: 10.3941/jrcr.v18i1.5217 -
Noise & HealthThis investigation sought to systematically assess music therapy's impact on aphasia and cognition in patients with post-stroke. (Meta-Analysis)
Meta-Analysis
PURPOSE
This investigation sought to systematically assess music therapy's impact on aphasia and cognition in patients with post-stroke.
METHODS
Comprehensive searches were performed across major databases, including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, and Vip Chinese sci-tech periodicals (VIP), covering publications up to December 2023. After screening and extracting data from the retrieved literature, its quality was appraised, which was followed by a meta-analysis using RevMan software (version 5.4, Cochrane Collaboration, Oxford, UK).
RESULTS
Nine articles, which were published from 2008 to 2022, were covered in this investigation, comprising 309 stroke patients in total. Meta-analysis results from these variations were found to be not statistically significant in the degree of functional communication improvement between the experimental group and the control group (standardized mean difference [SMD] = 0.23, 95% confidence interval [CI] (-0.19; 0.77), P > 0.05). These variations were found to be not statistically significant in the improvement of understanding ability in the experimental group compared with that in the control group (SMD = 0.21, 95% CI [-0.66; 1.09], P > 0.05). The degree of improvement in repetitive ability of the experimental group was considerably greater than that of the control group (SMD = 0.37, 95% CI [0.01; 0.76], P < 0.05). These variations were found to be not statistically significant in the improvement of naming ability in the experimental group compared with that in the control group (SMD = 0.30, 95% CI [-0.19; 0.80], P > 0.05). The cognitive score of the experimental group was considerably greater than that of the control group (SMD = 0.75, 95% CI [0.44; 1.06], P < 0.05).
CONCLUSION
Music therapy can effectively ameliorate the repetition ability of patients with aphasia after stroke. It can also improve the cognitive ability of patients. Thus, music therapy could be further applied to treat this type of patients.
Topics: Music Therapy; Humans; Aphasia; Cognition; Stroke; Stroke Rehabilitation
PubMed: 38904813
DOI: 10.4103/nah.nah_24_24