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Acta Neurochirurgica Mar 2023Patients with moyamoya disease (MMD) may exhibit higher brain dysfunction due to hypoperfusion, which may be ameliorated by revascularization. However, few studies have...
Patients with moyamoya disease (MMD) may exhibit higher brain dysfunction due to hypoperfusion, which may be ameliorated by revascularization. However, few studies have examined the relationship between cerebral perfusion and language function or the ameliorating effect of revascularization on language dysfunction. We present two cases with MMD who presented with alexia with agraphia, specifically for Japanese kanji. The patients had impaired perfusion in the left inferior temporal and lateral occipital lobes. Following superficial temporal artery-middle cerebral artery bypass, the symptoms improved dramatically. Thus, correction of hypoperfusion may be effective even in adult patients with MMD presenting with language dysfunction.
Topics: Humans; Adult; Agraphia; Moyamoya Disease; Dyslexia; Brain Diseases; Vascular Diseases; Cerebral Revascularization
PubMed: 36562875
DOI: 10.1007/s00701-022-05460-y -
Behavioural Neurology 2022The Arabic writing system includes ambiguities that create difficulties in spelling. These ambiguities relate mainly to the long vowels, some phoneme-grapheme...
The Arabic writing system includes ambiguities that create difficulties in spelling. These ambiguities relate mainly to the long vowels, some phoneme-grapheme conversions, lexical particularities, and the connectivity of letters. In this article, the first to specifically explore acquired spelling impairments in an Arabic-speaking individual, we report the case of CHS, who presented with agraphia following a stroke. Initial testing indicated substantial impairment of CHS's spelling abilities in the form of mixed agraphia. The experimental study was specifically designed to explore the influence of the orthographic ambiguity of the Arabic graphemic system on CHS's spelling performance. The results revealed that CHS had substantial difficulties with orthographic ambiguity and tended to omit ambiguous graphemes. Some of the errors she produced suggested reliance on the sublexical route of spelling, while others rather reflected the adoption of the lexical-semantic route. These findings from a case involving a non-Western, non-Indo-European language contribute to discussions of theoretical models of spelling. They show that CHS's pattern of impairment is consistent with the , according to which the lexical-semantic and the sublexical routes interactively contribute to spelling.
Topics: Female; Humans; Agraphia; Language; Semantics; Stroke
PubMed: 36439680
DOI: 10.1155/2022/8078607 -
Frontiers in Human Neuroscience 2022Language performance requires support from central cognitive/linguistic abilities as well as the more peripheral sensorimotor skills to plan and implement spoken and...
Language performance requires support from central cognitive/linguistic abilities as well as the more peripheral sensorimotor skills to plan and implement spoken and written communication. Both output modalities are vulnerable to impairment following damage to the language-dominant hemisphere, but much of the research to date has focused exclusively on spoken language. In this study we aimed to examine an integrated model of language processing that includes the common cognitive processes that support spoken and written language, as well as modality-specific skills. To do so, we evaluated spoken and written language performance from 87 individuals with acquired language impairment resulting from damage to left perisylvian cortical regions that collectively constitute the dorsal language pathway. Comprehensive behavioral assessment served to characterize the status of central and peripheral components of language processing in relation to neurotypical controls ( = 38). Performance data entered into principal components analyses (with or without control scores) consistently yielded a strong five-factor solution. In line with a primary systems framework, three central cognitive factors emerged: semantics, phonology, and orthography that were distinguished from peripheral processes supporting speech production and allographic skill for handwriting. The central phonology construct reflected performance on phonological awareness and manipulation tasks and showed the greatest deficit of all the derived factors. Importantly, this phonological construct was orthogonal to the speech production factor that reflected repetition of words/non-words. When entered into regression analyses, semantics and phonological skill were common predictors of language performance across spoken and written modalities. The speech production factor was also a strong, distinct predictor of spoken naming and oral reading, in contrast to allographic skills which only predicted written output. As expected, visual orthographic processing contributed more to written than spoken language tasks and reading/spelling performance was strongly reliant on phonological and semantic abilities. Despite the heterogeneity of this cohort regarding aphasia type and severity, the marked impairment of phonological skill was a unifying feature. These findings prompt greater attention to clinical assessment and potential treatment of underlying phonological skill in individuals with left perisylvian damage.
PubMed: 36419644
DOI: 10.3389/fnhum.2022.1025468 -
Neurology India 2022
Topics: Humans; Alexia, Pure; Agraphia; Reading
PubMed: 36352656
DOI: 10.4103/0028-3886.359157 -
Neuropathology : Official Journal of... Feb 2023Here, we describe two patients who presented with focal cortical signs and underwent neuropathological examination. Case 1 was a 73-year-old woman with progressive... (Review)
Review
Here, we describe two patients who presented with focal cortical signs and underwent neuropathological examination. Case 1 was a 73-year-old woman with progressive speech disorder and abnormal behavior. She showed agraphia of the frontal lobe type, featured by the omission of kana letters when writing, other than pyramidal tract signs, pseudobulbar palsy, and frontal lobe dementia. Neuropathological examination, including TAR DNA-binding protein 43 (TDP-43) immunohistochemistry, revealed bilateral frontal and anterior temporal lobe lesions accentuated in the precentral gyrus and posterior part of the middle frontal gyrus. Both upper and lower motor neurons showed pathological changes compatible with amyotrophic lateral sclerosis. Case 2 was a 62-year-old man with progressive speech disorder and hand clumsiness. He had a motor speech disorder, compatible with apraxia of speech, and limb apraxia of the limb-kinetic and ideomotor type. Neuropathological examination revealed degeneration in the left frontal lobe, including the precentral gyrus, anterior temporal, and parietal lobe cortices. Moreover, numerous argyrophilic neuronal intracytoplasmic inclusions (Pick body) and ballooned neurons were observed in these lesions and the limbic system. The pathological diagnosis was Pick disease involving the peri-Rolandic area and parietal lobe. In these two cases, the distribution of neuropathological changes in the cerebral cortices correlated with the clinical symptoms observed.
Topics: Male; Female; Humans; Aged; Middle Aged; Amyotrophic Lateral Sclerosis; Motor Neurons; Dementia; Temporal Lobe; Apraxias
PubMed: 36328774
DOI: 10.1111/neup.12854 -
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 -
Progress in Neuro-psychopharmacology &... Jan 2023Writing abilities are impacted by dysgraphia, a condition of learning disability. It might be challenging to diagnose dysgraphia at an initial point of a child's...
Writing abilities are impacted by dysgraphia, a condition of learning disability. It might be challenging to diagnose dysgraphia at an initial point of a child's upbringing. Problematic abilities linked to Dysgraphia difficulties that is utilized in detecting the learning disorder. The features used in this research to identify dysgraphia include handwriting and geometric features that is reclaimed using kekre-discrete cosine mathematical model. The feature learning step of deep transfer learning makes good use of the obtained features to identify dysgraphia. The results of the data collection indicate that this study can use handwritten images to detect children who have dysgraphia. Compared to past investigations, this experiment has shown a significant improvement in the capacity to identify dysgraphia using handwritten drawings. The proposed approach is compared with the machine learning and deep learning approaches where the Kekre-Discrete Cosine Transform with Deep Transfer Learning (K-DCT-DTL) outperforms the existing approaches. The proposed K-DCT-DTL approach attains 99.75% of highest accuracy that exhibits the efficiency of the proposed method.
Topics: Child; Humans; Agraphia; Deep Learning; Handwriting; Machine Learning; Learning Disabilities
PubMed: 36181958
DOI: 10.1016/j.pnpbp.2022.110647 -
Cortex; a Journal Devoted To the Study... Oct 2022When Gerstmann published the case report which later became known as the first case of Gerstmann syndrome, he did not claim the discovery of a new syndrome. It was only...
When Gerstmann published the case report which later became known as the first case of Gerstmann syndrome, he did not claim the discovery of a new syndrome. It was only a few years later, after reporting on another two similar cases, that he isolated the famous tetrad of symptoms (finger agnosia, right-left disorientation, agraphia and acalculia) as a meaningful cluster with both localising and functional value. In this article, we provide the translation of key-excerpts of the second of Gerstmann's reports (Gerstmann, 1927) and a synoptic description of the symptoms as reported in the three original cases, which were later identified as cases of Gerstmann syndrome. The descriptions appear highly consistent across cases. Among symptoms, finger agnosia stands out for its pervasiveness, which may explain why Gerstmann considered this as the core symptom and speculated it could subtend all symptoms. However, no common functional denominator emerges from the original descriptions.
Topics: Agnosia; Dyscalculia; Gerstmann Syndrome; Humans; Male; Translations
PubMed: 35998548
DOI: 10.1016/j.cortex.2022.07.002 -
International Journal of Language &... Nov 2022Written communication has become an increasingly important part of everyday life in social, educational and professional spheres. The substantial increase in writing via...
BACKGROUND
Written communication has become an increasingly important part of everyday life in social, educational and professional spheres. The substantial increase in writing via the internet and mobile technologies provides both an opportunity for social engagement and distinct challenges for people with aphasia. Within the current literature there has been limited research into the lived experiences of people with aphasia of their writing difficulties and how these affect their ability to communicate.
AIMS
This qualitative study aimed to explore the experiences of people with aphasia of living with language-related writing difficulties and the impact of these on their lives.
METHODS & PROCEDURES
Eight people with post-stroke aphasia and writing difficulties took part in semi-structured interviews. The interviews were analysed using inductive reflexive thematic analysis.
OUTCOMES & RESULTS
Two themes were found in the data. The first theme was a gradual and effortful improvement to writing: Participants described how writing had improved since their stroke due to strategies and support, but they still found writing to be difficult and frustrating and described many barriers to writing. The second theme was the importance of writing for fulfilling adult social roles: Participants found writing to be important for communicating with family, friends and organizations, but their participation in society and self-esteem and confidence were impacted by writing difficulties; reduced social roles meant reduced need for writing, but participants were still motivated to work towards writing goals.
CONCLUSIONS & IMPLICATIONS
The findings demonstrate the emerging importance of writing skills for people with aphasia with respect to communication, well-being, participation and inclusion in society, and carrying out social roles. They provide an insight into the process of improvement, including the difficulties, facilitators and barriers. Implications for speech and language therapy assessment and management are discussed.
WHAT THIS PAPER ADDS
What is already known on the subject People with aphasia have difficulties with writing that can affect their ability to communicate. A small body of qualitative research has provided insights into individuals' experiences of literacy difficulties. More research is needed to understand the writing experiences of people with aphasia to help design appropriate assessments and interventions. What this paper adds to existing knowledge Participants experienced gradual and effortful improvement since their stroke. They felt negative about aspects of their writing, including speed, accuracy and range of vocabulary. Writing was facilitated through assistive technologies, spelling practice and support from others; barriers included technology, lack of time, stroke-related symptoms and others' lack of awareness about aphasia. Participants considered writing skills to be important, particularly for communication, carrying out adult social roles and participating in society, and were therefore still working towards goals related to everyday writing activities. What are the potential or actual clinical implications of this work? This study suggests that speech and language therapy assessment should include interviewing participants about their activities, strengths, difficulties, facilitators and barriers in writing, and informal assessment of a range of functional writing tasks. Intervention should be tailored to the individual's needs. This should include meaningful activities that relate to functional everyday writing and, where appropriate, self-management, compensatory technologies and group approaches, while making use of existing strategies identified by the individual.
Topics: Adult; Humans; Aphasia; Speech Therapy; Agraphia; Stroke Rehabilitation; Stroke; Writing
PubMed: 35929726
DOI: 10.1111/1460-6984.12762