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Neurointervention Jul 2024Delayed ischemic stroke associated with intractable vasospasm after clipping of unruptured intracranial aneurysms (UIAs) has been rarely reported. We report a patient...
Delayed ischemic stroke associated with intractable vasospasm after clipping of unruptured intracranial aneurysms (UIAs) has been rarely reported. We report a patient with delayed ischemic stroke associated with intractable vasospasm following UIA clipping. A middle-aged female underwent surgery for unruptured middle cerebral artery bifurcation aneurysms. The patient tolerated the neurosurgical procedure well. Seven days postoperatively, the headache was unbearable; a postcraniotomy headache persisted and abruptly presented with global aphasia and right-sided hemiplegia after a nap. Emergency digital subtraction angiography showed severe luminal narrowing with segmental vasoconstriction, consistent with severe vasospasm. The patient's neurological deficit improved after chemical angioplasty. Neurosurgeons should pay close attention to this treatable/preventive entity after neurological deterioration following UIA clipping, even in patients without subarachnoid hemorrhage.
PubMed: 38871004
DOI: 10.5469/neuroint.2024.00150 -
Neurological Research and Practice Jun 2024To examine the influence of interpreter service needs (IS) on rt-PA administration time metrics.
AIM
To examine the influence of interpreter service needs (IS) on rt-PA administration time metrics.
METHODS
Retrospectively reviewed prospectively collected data from Comprehensive Stroke Center database (January 2011- April 1, 2021) and EMR.
INCLUSION
Subjects for whom a "stroke code" was activated. Excluded in-house strokes. Baseline characteristics, frequency of rt-PA, rt-PA exclusions and time metrics, NIHSS were compared between patients who did or did not require IS. Analyses utilized ANOVA, t-Test, Brown-Mood Median Test, or Pearson's Chi-squared test as appropriate.
RESULTS
Of 2,191 patients with stroke code activations, 81 had a documented need for IS. Rt-PA was administered in 9 IS and 358 non-IS patients. Median baseline NIHSS was higher in rt-PA group (9±8 vs 3±9, p<0.005). In IS patients, there were no differences in baseline characteristics between those who received rt-PA and those who did not, including median score for NIHSS aphasia (0±1 vs 0±1, p = 0.46). There were no rt-PA rate differences between those that did not and did require IS (17% vs 11%, p = 0.22). In patients with final diagnosis acute ischemic stroke, patients excluded from rt-PA solely due to being out of the window were more likely to have required IS (59% vs 35%, p = 0.003). Time metrics of rt-PA administration were not different in IS patients.
CONCLUSIONS
There was no significant difference in frequency or time metrics of rt-PA administration in patients requiring interpreter services during an acute stroke code. AIS patients requiring an interpreter were more likely to be excluded from rt-PA on the basis of time.
PubMed: 38867340
DOI: 10.1186/s42466-024-00319-2 -
Communications Medicine Jun 2024Emerging evidence suggests that post-stroke aphasia severity depends on the integrity of the brain beyond the lesion. While measures of lesion anatomy and brain...
BACKGROUND
Emerging evidence suggests that post-stroke aphasia severity depends on the integrity of the brain beyond the lesion. While measures of lesion anatomy and brain integrity combine synergistically to explain aphasic symptoms, substantial interindividual variability remains unaccounted. One explanatory factor may be the spatial distribution of morphometry beyond the lesion (e.g., atrophy), including not just specific brain areas, but distinct three-dimensional patterns.
METHODS
Here, we test whether deep learning with Convolutional Neural Networks (CNNs) on whole brain morphometry (i.e., segmented tissue volumes) and lesion anatomy better predicts chronic stroke individuals with severe aphasia (N = 231) than classical machine learning (Support Vector Machines; SVMs), evaluating whether encoding spatial dependencies identifies uniquely predictive patterns.
RESULTS
CNNs achieve higher balanced accuracy and F1 scores, even when SVMs are nonlinear or integrate linear or nonlinear dimensionality reduction. Parity only occurs when SVMs access features learned by CNNs. Saliency maps demonstrate that CNNs leverage distributed morphometry patterns, whereas SVMs focus on the area around the lesion. Ensemble clustering of CNN saliencies reveals distinct morphometry patterns unrelated to lesion size, consistent across individuals, and which implicate unique networks associated with different cognitive processes as measured by the wider neuroimaging literature. Individualized predictions depend on both ipsilateral and contralateral features outside the lesion.
CONCLUSIONS
Three-dimensional network distributions of morphometry are directly associated with aphasia severity, underscoring the potential for CNNs to improve outcome prognostication from neuroimaging data, and highlighting the prospective benefits of interrogating spatial dependence at different scales in multivariate feature space.
PubMed: 38866977
DOI: 10.1038/s43856-024-00541-8 -
NMC Case Report Journal 2024Stroke-like migraine attacks after radiation therapy (SMART) syndrome, a delayed sequela of cranial radiotherapy encountered rarely, occurs due to transient neurological...
Stroke-like migraine attacks after radiation therapy (SMART) syndrome, a delayed sequela of cranial radiotherapy encountered rarely, occurs due to transient neurological deficits coupled with migraine episodes. This case report describes an occurrence of SMART syndrome in an individual 8 years after receiving medulloblastoma treatment. The subject, a 21-year-old male, experienced abrupt aphasia and right-sided hemiparesis. Arterial spin labeling (ASL) revealed initial cerebral hypoperfusion in the left temporal and parietal regions, with no tumor resurgence or notable ischemic alterations. Two days later, the symptoms disappeared completely; nevertheless, at that time, ASL presented cerebral hyperperfusion in the same lobule. The subject experienced a pulsating headache and nausea the next day. In the context of SMART syndrome, this fluctuation in cerebral blood flow indicated by ASL is a unique finding. The significance of this case lies in the documentation of the dynamic evolution of cerebral perfusion in SMART syndrome via ASL, thereby elucidating its underlying pathophysiology. As hemiplegic migraine shows a similar cerebral perfusion pattern to SMART syndrome, we inferred an unexplored but shared pathophysiology among hemiplegic migraine and SMART syndrome. Through this successful capture of these distinct cerebral blood flow alterations, from hypoperfusion to hyperperfusion, our understanding of the pathophysiological intricacies inherent to SMART syndrome will be enhanced.
PubMed: 38863579
DOI: 10.2176/jns-nmc.2024-0037 -
Communications Biology Jun 2024Premature brain aging is associated with poorer cognitive reserve and lower resilience to injury. When there are focal brain lesions, brain regions may age at different...
Premature brain aging is associated with poorer cognitive reserve and lower resilience to injury. When there are focal brain lesions, brain regions may age at different rates within the same individual. Therefore, we hypothesize that reduced gray matter volume within specific brain systems commonly associated with language recovery may be important for long-term aphasia severity. Here we show that individuals with stroke aphasia have a premature brain aging in intact regions of the lesioned hemisphere. In left domain-general regions, premature brain aging, gray matter volume, lesion volume and age were all significant predictors of aphasia severity. Increased brain age following a stroke is driven by the lesioned hemisphere. The relationship between brain age in left domain-general regions and aphasia severity suggests that degradation is possible to specific brain regions and isolated aging matters for behavior.
Topics: Humans; Aphasia; Female; Male; Middle Aged; Aged; Brain; Aging, Premature; Magnetic Resonance Imaging; Stroke; Aging; Severity of Illness Index; Gray Matter; Adult
PubMed: 38862747
DOI: 10.1038/s42003-024-06211-8 -
The American Journal of Case Reports Jun 2024BACKGROUND Penetrating traumatic brain injury (TBI) caused by gunshots is a rare type of TBI that leads to poor outcomes and high mortality rates. Conducting a formal...
BACKGROUND Penetrating traumatic brain injury (TBI) caused by gunshots is a rare type of TBI that leads to poor outcomes and high mortality rates. Conducting a formal neuropsychological evaluation concerning a patient's neurologic status during the chronic recovery phase can be challenging. Furthermore, the clinical assessment of survivors of penetrating TBI has not been adequately documented in the available literature. Severe TBI in patients can provide valuable information about the functional significance of the damaged brain regions. This information can help inform our understanding of the brain's intricate neural network. CASE REPORT We present a case of a 29-year-old right-handed man who sustained a left-hemisphere TBI after a gunshot, causing extensive diffuse damage to the left cerebral and cerebellar hemispheres, mainly sparing the right hemisphere. The patient survived. The patient experienced spastic right-sided hemiplegia, facial hemiparesis, left hemiparesis, and right hemianopsia. Additionally, he had severe global aphasia, which caused difficulty comprehending verbal commands and recognizing printed letters or words within his visual field. However, his spontaneous facial expressions indicating emotions were preserved. The patient received a thorough neuropsychological assessment to evaluate his functional progress following a severe TBI and is deemed to have had a favorable outcome. CONCLUSIONS Research on cognitive function recovery following loss of the right cerebral hemisphere typically focuses on pediatric populations undergoing elective surgery to treat severe neurological disorders. In this rare instance of a favorable outcome, we assessed the capacity of the fully developed right hemisphere to sustain cognitive and emotional abilities, such as language.
Topics: Humans; Male; Adult; Wounds, Gunshot; Recovery of Function; Brain Injuries, Traumatic; Neuropsychological Tests; Head Injuries, Penetrating; Hemiplegia; Aphasia
PubMed: 38859569
DOI: 10.12659/AJCR.941601 -
Beyoglu Eye Journal 2024Optic aphasia is a rare neurological disorder that affects the visual-semantic ability of patients with normal vision and is caused by a lesion in the left occipital...
Optic aphasia is a rare neurological disorder that affects the visual-semantic ability of patients with normal vision and is caused by a lesion in the left occipital lobe. The signs and symptoms of optic aphasia are similar to those of associative visual agnosia, where patients have difficulty recognizing objects both in shape and function, resulting in challenges performing daily tasks. The transformation to optic aphasia or associative visual agnosia is closely related to the degree of damage to the corpus callosum, with some studies hypothetically suggesting that complete damage to the corpus callosum leads to optic aphasia, whereas incomplete damage causes associative visual agnosia. We present a case of a 60-year-old man with a history of intracerebral hemorrhage in the left occipitotemporoparietal lobe. The patient complained of intermittent episodes of painless, blurry vision. Upon examination, we observed that the patient was unable to read the Snellen chart, although he could draw the letter. Furthermore, we discovered that the patient had difficulty naming objects and instruments, even though he was able to express their shape and function through gestures and mimicry. The signs and symptoms of the patient, along with the result of the multi-slice non-contrast CT scan, suggest that he had optic aphasia rather than associative visual agnosia. A comprehensive neuropsychological and aphasia examination needs to be performed to further assess the condition of our patient and establish the diagnosis.
PubMed: 38854903
DOI: 10.14744/bej.2024.43765 -
International Medical Case Reports... 2024Meningovascular syphilis, a distinct classification of neurosyphilis, has gained attention for its association with cerebral ischemia, particularly among individuals...
BACKGROUND
Meningovascular syphilis, a distinct classification of neurosyphilis, has gained attention for its association with cerebral ischemia, particularly among individuals living with HIV. This unique manifestation of syphilis affects the meningeal and vascular structures of the central nervous system, leading to cerebrovascular complications. In this case report, we present the case of a young man diagnosed with neurosyphilis and HIV after presenting with an ischemic stroke. We discuss the challenges associated with diagnosing neurosyphilis, given its frequent atypical presentations that can mimic other diseases. Furthermore, we explore the management approach for these coexisting conditions.
CASE PRESENTATION
A right-handed male patient presented with a sudden paresis of the right upper and lower extremities, along with facial deviation to the left, and demonstrated low verbal output, limitation in constructing sentences, and conveying thoughts or ideas effectively. Upon admission, the patient's neurological examination revealed a FOUR coma scale of 16. He exhibited motor aphasia, right facial paralysis sparing the forehead, and right upper and lower extremity spastic hemiparesis with a strength of 3 out of 5 on the Medical Research Council scale. The Plantar reflex was positive on the affected side. Brain magnetic resonance imaging revealed left middle cerebral artery infarction (cortical and lenticulostriate territory acute infarction).
CONCLUSION
This case highlights the need for treating physician to have a high index of suspicion towards meningovascular syphilis as a potential cause of stroke in young individuals. This is crucial, especially when there is also a concurrent HIV infection, as it requires specific treatment.
PubMed: 38854842
DOI: 10.2147/IMCRJ.S455675 -
Communications Biology Jun 2024Thalamic aphasia results from focal thalamic lesions that cause dysfunction of remote but functionally connected cortical areas due to language network perturbation....
Thalamic aphasia results from focal thalamic lesions that cause dysfunction of remote but functionally connected cortical areas due to language network perturbation. However, specific local and network-level neural substrates of thalamic aphasia remain incompletely understood. Using lesion symptom mapping, we demonstrate that lesions in the left ventrolateral and ventral anterior thalamic nucleus are most strongly associated with aphasia in general and with impaired semantic and phonemic fluency and complex comprehension in particular. Lesion network mapping (using a normative connectome based on fMRI data from 1000 healthy individuals) reveals a Thalamic aphasia network encompassing widespread left-hemispheric cerebral connections, with Broca's area showing the strongest associations, followed by the superior and middle frontal gyri, precentral and paracingulate gyri, and globus pallidus. Our results imply the critical involvement of the left ventrolateral and left ventral anterior thalamic nuclei in engaging left frontal cortical areas, especially Broca's area, during language processing.
Topics: Humans; Male; Middle Aged; Female; Ventral Thalamic Nuclei; Aphasia; Magnetic Resonance Imaging; Stroke; Thalamus; Aged; Adult; Connectome; Frontal Lobe; Nerve Net; Neural Pathways
PubMed: 38849518
DOI: 10.1038/s42003-024-06399-9 -
Frontiers in Neurology 2024The efficacy of neurologic music therapy (NMT) techniques for the treatment of non-fluent aphasia has been widely accepted by the rehabilitation medical community....
INTRODUCTION
The efficacy of neurologic music therapy (NMT) techniques for the treatment of non-fluent aphasia has been widely accepted by the rehabilitation medical community. However, consensus on which dimensions of speech function can be improved by NMT techniques and standardized intervention dosage remains elusive. This study aimed to provide evidence regarding the efficacy of NMT in improving speech function and explore the optimal intervention dose. A systematic review and meta-analysis were conducted to search for randomized clinical trials and open-label trials that evaluated speech functions after NMT.
METHODS
We searched all papers and reviews published from database inception to July 2023, including PubMed, Cochrane Library, Web of Science, Embase, and CNKI. Statistical analyses were mainly carried out on RevManV5.4.1 and pooled using a random-effects model. The primary outcome was the standardized mean difference (SMD) in speech functions, determined by calculating the change in speech functions score from baseline to the primary endpoint in the NMT group versus the control arm.
RESULTS
A total of 11 studies with 329 patients were included. NMT had a positive effect on repetition ability (SMD = 0.37, 95%CI [0.12, 0.62], < 0.05), but did not lead to significant differences in naming, comprehension, spontaneous speech, or communication. When the intervention time was >20 h, NMT exhibited a significant advantage at improving repetition ability (SMD = 0.43, 95%CI [0.06, 0.79], < 0.05).
DISCUSSION
This study provides evidence supporting the NMT enhancement of repetition ability in patients with non-fluent aphasia. Future large-sample studies are required to determine the optimal intervention dose of music therapy for different subtypes of non-fluent aphasia.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42023470313.
PubMed: 38846040
DOI: 10.3389/fneur.2024.1395312