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Acta Neuropathologica Communications Aug 2021Although the right temporal variant frontotemporal dementia (rtvFTD) is characterised by distinct clinical and radiological features, its underlying histopathology...
Although the right temporal variant frontotemporal dementia (rtvFTD) is characterised by distinct clinical and radiological features, its underlying histopathology remains elusive. Being considered a right-sided variant of semantic variant primary progressive aphasia (svPPA), TDP-43 type C pathology has been linked to the syndrome, but this has not been studied in detail in large cohorts. In this case report and systematic review, we report the autopsy results of five subjects diagnosed with rtvFTD from our cohort and 44 single rtvFTD subjects from the literature. Macroscopic pathological evaluation of the combined results revealed that rtvFTD demonstrated either a frontotemporal or temporal evolution, even if the degeneration started in the right temporal lobe initially. FTLD-TDP type C was the most common underlying pathology in rtvFTD, however, in 64% of rtvFTD, other underlying pathologies than FTLD-TDP type C were present, such as Tau-MAPT and FTLD-TDP type A and B. Additionally, accompanying motor neuron or corticospinal tract degeneration was observed in 28% of rtvFTD patients. Our results show that in contrast to the general assumption, rtvFTD might not be a pure FTLD-TDP type C disorder, unlike its left temporal counterpart svPPA. Large sample size pathological studies are warranted to understand the diverse pathologies of the right and left temporal variants of frontotemporal dementia.
Topics: Aged; Aphasia, Primary Progressive; DNA-Binding Proteins; Female; Frontotemporal Dementia; Functional Laterality; Humans; Male; Middle Aged; Neuropsychological Tests
PubMed: 34344452
DOI: 10.1186/s40478-021-01229-z -
Frontiers in Neurology 2021The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior...
The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual-motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix-Chavany-Marie syndrome, social communication deficit in autism spectrum disorders, and attention-deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.
PubMed: 33732210
DOI: 10.3389/fneur.2021.641586 -
Neurological Sciences : Official... May 2021The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may... (Review)
Review
BACKGROUND AND PURPOSE
The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis).
METHODS
We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords "insular stroke" and "insular infarction", to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed.
RESULTS
We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache.
CONCLUSIONS
The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.
Topics: Aphasia; Cerebral Cortex; Dysarthria; Female; Humans; Male; Speech; Stroke
PubMed: 33575921
DOI: 10.1007/s10072-021-05109-1 -
European Journal of Physical and... Feb 2021Speech difficulties, such as dysarthria or aphasia, in addition to motor impairments are frequently seen in post-stroke patients. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Speech difficulties, such as dysarthria or aphasia, in addition to motor impairments are frequently seen in post-stroke patients.
EVIDENCE ACQUISITION
Literature searches with the keywords: "stroke" and "dysarthria" and "diagnosis" and "stroke" and "dysarthria" and "assessment" were conducted using PubMed, EMBASE, Cochrane Library, and Web of Science databases to perform the systematic review about the methods used to measure the severity of dysarthria in subjects post-stroke. The search was performed by two authors from 15 January to 22 February 2020. The research identified a total of 402 articles for the search using the keywords "stroke" and "dysarthria," and "diagnosis" and 84 references for the search using the keywords "stroke" and "dysarthria" and "assessment." Sixty-nine selected articles were analyzed by the reviewers. Thirty-seven publications met the inclusion criteria and were included in the systematic review. Thirty-two articles were excluded for several reasons: 1) 12 involved individuals with aphasia or other speech problems different from dysarthria; 2) 12 examined different topics from our aim; and 3) eight did not include post-stroke cases.
EVIDENCE SYNTHESIS
The systematic review identified methods for measuring the severity of post-stroke dysarthria. The meta-analysis showed the acoustic parameters affected in dysarthria secondary to stroke and the differences in these parameters after speech therapy.
CONCLUSIONS
The alternating and sequential motion rate (AMR- Pə, AMR-Tə, AMR-Kə, and SMR-PəTəKə) and maximum phonation time were significantly improved after speech rehabilitation.
Topics: Dysarthria; Humans; Speech Therapy; Stroke Rehabilitation
PubMed: 32519528
DOI: 10.23736/S1973-9087.20.06242-5 -
European Journal of Physical and... Oct 2020Speech difficulties such as dysarthria or aphasia are frequently seen, in addition to motor impairments, in subjects after stroke.
INTRODUCTION
Speech difficulties such as dysarthria or aphasia are frequently seen, in addition to motor impairments, in subjects after stroke.
EVIDENCE ACQUISITION
Literature searches with the keywords: "stroke" AND "dysarthria" AND "speech therapy" OR "language therapy" were conducted in PubMed, EMBASE, Cochrane Library and Web of Science to perform the systematic review about the several strategies used to treat dysarthria in subjects after stroke. The search was performed independently by two authors (CR and VM) from December 15 2019 to January 15 2020, using the PICOS criteria: participants were aging adults (>18 years old) affected by stroke; intervention was based on rehabilitation speech therapy; comparator was any comparator (all logopedic and speech rehabilitation tools); outcomes included clinical assessments, diagnostic scales and acoustic analysis of voice; and study design was RCTs, case series and case report, observational studies. The research identified a total of 94 articles for the first search and 56 for the second search. Sixty selected articles were analyzed by the reviewers. Twenty-five publications met the inclusion criteria and were included in the systematic review. Thirty-three articles were excluded for the following reasons: 12 involved individuals with aphasia or other speech problems different from dysarthria, 10 examined the clinical features of dysarthria, 3 treated on the impact of dysarthria on social participation following stroke, 8 did not include cases after stroke.
EVIDENCE SYNTHESIS
A systematic review was performed to identify the main used speech rehabilitation treatments for dysarthria after stroke. We defined the several techniques to better guide the physician to delineate a speech rehabilitation protocol adopting the better strategies described in the current literature.
CONCLUSIONS
This systematic review tried to provide to the reader a complete overview of the literature of all possible different speech treatments for dysarthria after stroke. A correct protocol could permit to improve the communication and the quality of life of these subjects.
Topics: Dysarthria; Humans; Speech Therapy; Stroke
PubMed: 32434313
DOI: 10.23736/S1973-9087.20.06185-7 -
Journal of Rehabilitation Medicine Feb 2020To evaluate evidence from published systematic reviews of clinical trials to determine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in stroke...
OBJECTIVE
To evaluate evidence from published systematic reviews of clinical trials to determine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in stroke population.
METHODS
The Cochrane Library, MEDLINE, CINAHL, EMBASE, and PubMed were searched for systematic reviews up to 15 January 2019. Three authors independently screened the reviews and assessed the methodological quality, using Assessment of Multiple Systematic Reviews (AMSTAR) appraisal tool. Quality of evidence for outcomes evaluated within the reviews was appraised with Grade of Recommendation, Assessment, Development and Evaluation (GRADE) tool.
RESULTS
Twelve reviews (n = 9,117 participants) evaluated the effectiveness of rTMS on motor and non-motor (aphasia, depression, dysphagia and cognition) functions. The rTMS protocols applied and outcomes measured were diverse amongst the selected reviews. The findings suggest beneficial effect of rTMS with: "moderate quality" evidence for dysphagia and hemineglect, "low to moderate quality" evidence for motor function (upper limb function, daily activities), and "low quality" evidence for aphasia and post-stroke depression.
CONCLUSION
Despite widespread use of rTMS, high-quality evidence for its routine use for the treatment of stroke survivors is lacking. Further studies are required to establish differential roles of various protocols and long-term effects of rTMS in the stroke population.
Topics: Humans; Stroke; Stroke Rehabilitation; Transcranial Magnetic Stimulation
PubMed: 31922207
DOI: 10.2340/16501977-2637 -
BMC Emergency Medicine Sep 2019Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a...
INTRODUCTION
Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a number of clinical assessment tools have been developed and this review examines their diagnostic capabilities.
METHODS
Diagnostic performance of currently available clinical tools for identification of acute ischaemic and haemorrhagic strokes and stroke mimicking conditions was reviewed. A systematic search of the literature published in 2015-2018 was conducted using PubMed, EMBASE, Scopus and The Cochrane Library. Prehospital and in-hospital studies with a minimum sample size of 300 patients reporting diagnostic accuracy were selected.
RESULTS
Twenty-five articles were included. Cortical signs (gaze deviation, aphasia and neglect) were shown to be significant indicators of large vessel occlusion (LVO). Sensitivity values for selecting subjects with LVO ranged from 23 to 99% whereas specificity was 24 to 97%. Clinical tools, such as FAST-ED, NIHSS, and RACE incorporating cortical signs as well as motor dysfunction demonstrated the best diagnostic accuracy. Tools for identification of stroke mimics showed sensitivity varying from 44 to 91%, and specificity of 27 to 98% with the best diagnostic performance demonstrated by FABS (90% sensitivity, 91% specificity). Hypertension and younger age predicted intracerebral haemorrhage whereas history of atrial fibrillation and diabetes were associated with ischaemia. There was a variation in approach used to establish the definitive diagnosis. Blinding of the index test assessment was not specified in about 50% of included studies.
CONCLUSIONS
A wide range of clinical assessment tools for selecting subjects with acute stroke has been developed in recent years. Assessment of both cortical and motor function using RACE, FAST-ED and NIHSS showed the best diagnostic accuracy values for selecting subjects with LVO. There were limited data on clinical tools that can be used to differentiate between acute ischaemia and haemorrhage. Diagnostic accuracy appeared to be modest for distinguishing between acute stroke and stroke mimics with optimal diagnostic performance demonstrated by the FABS tool. Further prehospital research is required to improve the diagnostic utility of clinical assessments with possible application of a two-step clinical assessment or involvement of simple brain imaging, such as transcranial ultrasonography.
Topics: Diagnosis, Differential; Humans; Ischemic Attack, Transient; Sensitivity and Specificity; Severity of Illness Index; Stroke
PubMed: 31484499
DOI: 10.1186/s12873-019-0262-1