-
Actas Espanolas de Psiquiatria Feb 2024Stroke survivors usually present physical and neuropsychiatric complications. Post-stroke psychosis (PSPsy) is a particularly neglected sequel despite its disruptive...
INTRODUCTION
Stroke survivors usually present physical and neuropsychiatric complications. Post-stroke psychosis (PSPsy) is a particularly neglected sequel despite its disruptive nature.
OBJECTIVES
To present a case of early emerging neuropsychiatric symptoms following a left posterior cerebral artery (PCA) stroke. To review and discuss PSPsy clinical manifestations, pathophysiology, and clinical outcomes.
CLINICAL CASE
A previously autonomous 68-year-old woman with vascular risk factors and depressive disorder presented to the emergency department with a 5-day history of disorientation, motor aphasia, and right hypoesthesia. Computer tomography revealed a left PCA stroke. She was started on acetylsalicylic acid and rosuvastatin and discharged the next day. Afterward, the patient developed a depressive mood, emotional lability, periods of confusion, delusions of persecution, guilt and unworthiness, auditory hallucinations, and suicide ideation. She was admitted to a psychiatric hospital and started on risperidone with a good response, being discharged after 15 days with the resolution of psychiatric symptoms.
CONCLUSIONS
PSPsy is more common after right hemisphere lesions and usually develops after some months. Nevertheless, our patient presented PSPsy following an ischemic event of the left PCA, with neuropsychiatric symptomatology dominating the clinic since the beginning. The involvement of the retrosplenial cortex or its connections was likely important for this atypical presentation. Due to the lack of guidelines on approaching PSPsy, most patients are treated with the same strategies used for non-stroke patients. A better comprehension of the anatomical basis underlining the symptomatology in these patients could deepen the understanding of psychosis and psychotic disorders.
Topics: Aged; Female; Humans; Hallucinations; Infarction, Posterior Cerebral Artery; Personality Disorders; Posterior Cerebral Artery; Psychotic Disorders
PubMed: 38454893
DOI: No ID Found -
World Neurosurgery: X Apr 2024Brain Arteriovenous Malformations (AVMs) located in proximity to eloquent brain regions are associated with poor surgical outcomes, which may be due to higher rates of... (Review)
Review
BACKGROUND
Brain Arteriovenous Malformations (AVMs) located in proximity to eloquent brain regions are associated with poor surgical outcomes, which may be due to higher rates of postoperative neurological deterioration. Current treatment protocols include stereotactic radiosurgery, transarterial embolization, and surgical resection under general anesthesia. Awake Craniotomy (AC) allows intraoperative mapping of eloquent areas to improve post-operative neurologic outcomes.
OBJECTIVES
We reviewed the current literature reporting surgical outcomes and assessed the feasibility of AC for AVM resection.
METHODS
The PRISMA guidelines were utilized as a template for the review. Three databases including PubMed, Scopus, and Cochrane Library were searched using a predefined search strategy. After removing duplicates and screening, full texts were analyzed. Outcomes including the extent of resection, intra-operative and post-operative complications, and long-term neurologic outcomes were assessed.
RESULTS
12 studies were included with a total of 122 AVM cases. Spetzler-Martin grading was used for the classification of the AVMs. The asleep-awake-asleep protocol was most commonly used for AC. Complete resection was achieved in all cases except 5. Intraoperative complications included seizures (n = 2) and bleeding (n = 4). Short-term post-operative complications included hemorrhage (n = 3), neurologic dysfunctions including paresis (n = 3), hemiplegia (n = 10), dysphasia/aphasia (n = 6), cranial nerve dysfunction (n = 3), and pulmonary embolism (n = 1). Almost all neurological deficits after surgery gradually improved on subsequent follow-ups.
CONCLUSION
AVMs may shift the anatomical location of eloquent brain areas which may be mapped during AC. All studies recommended AC for the resection of AVMs in close proximity to eloquent areas as mapping during AC identifies the eloquent cortex thus promoting careful tissue handling which may preserve neurologic function and/or predict the postoperative functional status of the patients We, therefore, conclude that AC is a viable modality for AVMs resection near eloquent language and motor areas.
PubMed: 38440377
DOI: 10.1016/j.wnsx.2024.100321 -
BMC Geriatrics Mar 2024To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice.
DATA SOURCES
Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023.
STUDY SELECTION
Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex.
DATA EXTRACTION
Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded.
DATA SYNTHESIS
36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05).
CONCLUSIONS
There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.
Topics: Female; Humans; Male; Incidence; Aphasia; Stroke; Patient Compliance
PubMed: 38438862
DOI: 10.1186/s12877-024-04765-0 -
Frontiers in Neuroscience 2024Anodal transcranial Direct Current Stimulation (tDCS) is a non-invasive, low-cost and environment-friendly brain neuromodulation technique that increases cortical...
INTRODUCTION
Anodal transcranial Direct Current Stimulation (tDCS) is a non-invasive, low-cost and environment-friendly brain neuromodulation technique that increases cortical excitability. In post-stroke aphasia, the role of the right hemisphere in language recovery remains debated. In this preliminary study, we aimed to investigate the efficacy of excitatory tDCS on the right hemisphere in chronic aphasic patients.
METHODS
We applied anodal tDCS to the right homologous region of Broca's area in four chronic aphasic patients while performing a one-month naming rehabilitation treatment. Longitudinal data on language assessment and naming performance were collected. Resting-state fMRI images were acquired before and after treatment to measure changes in functional connectivity.
RESULTS
Results showed enhanced positive functional connectivity of the right Broca homologous with the left middle frontal and middle temporal gyri. Every patient showed improvements in language functions, but no major changes in naming performance.
CONCLUSION
These preliminary findings suggest that tDCS applied over the unaffected hemisphere may result in longitudinal inter-hemispheric functional neuroplastic changes that could specifically improve language recovery and could potentially be included in therapeutic neurorehabilitative plans.
PubMed: 38406588
DOI: 10.3389/fnins.2024.1346095 -
Brain Sciences Jan 2024The surgical treatment of paediatric thalamic gliomas has been burdened with high morbidity, and these lesions were often considered inoperable. With new approaches and...
The surgical treatment of paediatric thalamic gliomas has been burdened with high morbidity, and these lesions were often considered inoperable. With new approaches and intraoperative technologies, we can remove tumours once deemed inoperable. In our single centre, we have operated on 11 paediatric patients over the course of 8 years. We have performed eight GTR resections and three intended subtotal resections. The postoperative neurological deficit ranged from mild to very severe for motor weakness and none to severe for aphasia after surgery, with all of the patients improving at 3-month follow-up. Radicality in the surgical approach to thalamic gliomas in children has shown significant benefits when compared to more conservative approaches. For children with LGGs, extensive surgical resection is associated with improved prognosis and longer progression-free survival. However, it does not yield the same proportional benefit for HGGs due to its aggressive nature and worse outlook.
PubMed: 38391716
DOI: 10.3390/brainsci14020141 -
BJR Case Reports Jan 2024Heroin-induced leukoencephalopathy (HLE) is a rare toxic encephalopathy associated primarily with heroin inhalation, commonly referred to as "chasing the dragon." This...
Heroin-induced leukoencephalopathy (HLE) is a rare toxic encephalopathy associated primarily with heroin inhalation, commonly referred to as "chasing the dragon." This study presents a clinical case of a 27-year-old polydrug user diagnosed with HLE during hospitalization for rapidly progressive flaccid tetraplegia and aphasia. The clinical manifestations encompassed cerebellar and bulbar dysfunction, coupled with motor impairment and altered consciousness. Based on the clinical data and MRI results, HLE was identified as the most likely cause. This article aims to provide insights into the clinical and radiological aspects of HLE, emphasizing the diagnostic significance of radiological findings. The gold standard examination for diagnosis is MRI, crucial due to the difficulties in obtaining histological confirmation for this rare condition.
PubMed: 38352254
DOI: 10.1093/bjrcr/uaad004 -
Clinical Case Reports Feb 2024Apraxia of speech (AOS) due to a postcentral infarction differs from conventional precentral AOS with respect to phonemic errors (phoneme substitution) which are more...
KEY CLINICAL MESSAGE
Apraxia of speech (AOS) due to a postcentral infarction differs from conventional precentral AOS with respect to phonemic errors (phoneme substitution) which are more common than phonetic errors (phoneme distortion) and preserved accent and intonation.
ABSTRACT
Clinical features of apraxia of speech caused by lesions in the postcentral gyrus have not yet been elucidated. Here, we report a patient with this lesion and show how postcentral apraxia of speech differs from the hitherto known precentral apraxia of speech. A 54-year-old man developed Broca's aphasia with apraxia of speech that resolved into pure apraxia of speech within 3 weeks following infarction of the postcentral gyrus. The diagnosis of apraxia of speech was based on the patient's effortful, slow speech and inconsistent phonetic distortions with phonemic paraphasia. The Western Aphasia Battery was used to examine the patient's speech samples. Speech was recorded using a digital voice recorder and transcribed into a narrow transcription of the International Phonetic Alphabet. The error types were categorized phonologically. The results revealed that (a) phonemic errors (vowel and consonant substitutions, also known as phonemic paraphasia) were more common than phonetic errors (vowel and consonant distortions). Similar to conduction aphasia, phonemic errors were more pronounced in confrontation naming than in repetition, accompanied by self-correction, and (b) word accent and sentence intonation were preserved, although the speech was slow. These two features are characteristic of postcentral apraxia of speech, which can be differentiated from conventional precentral apraxia of speech.
PubMed: 38344353
DOI: 10.1002/ccr3.8499 -
Verb Tense Production in People With Nonfluent Aphasia Across Different Discourse Elicitation Tasks.American Journal of Speech-language... May 2024Verb tense production is known to be impaired in people with nonfluent aphasia. Selective past tense impairment in this population has been reported, but results are...
PURPOSE
Verb tense production is known to be impaired in people with nonfluent aphasia. Selective past tense impairment in this population has been reported, but results are inconsistent and lacking at the discourse level. In addition, language production can be affected by discourse elicitation tasks depending on the cognitive linguistic demands and instructions unique to each task. There is limited evidence regarding whether verb tense production in people with nonfluent aphasia is impacted by discourse task demands. Understanding this potential impact is important for clinicians and researchers who are interested in assessing and then identifying effective clinical goals for this population. Therefore, this study aimed to investigate the trends of verb tense production across various discourse elicitation tasks in people with nonfluent aphasia compared to people without aphasia.
METHOD
Language samples for 23 people with nonfluent aphasia and 27 people without aphasia were obtained for six discourse tasks from the AphasiaBank database. We calculated ratios of past tense, present tense, future tense, imperative, and unknown verb types to compare which tense was used most frequently within and across the tasks and groups.
RESULTS AND CONCLUSIONS
Our findings revealed evidence of verb tense production deficits and a selective past tense impairment in people with nonfluent aphasia. Discourse task effects were shown for people without aphasia but were scarce in people with nonfluent aphasia. This finding could be explained by an overall reduction of verb production and overreliance on present tense production in nonfluent aphasia. These results suggest the potential methodological implications of using different discourse tasks to evaluate verb tense production in people with nonfluent aphasia. Future studies need to evaluate discourse task effects on other aspects of verb production (e.g., moods) and specific task factors (e.g., presence or absence of visual stimulus).
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.25146242.
Topics: Humans; Male; Female; Middle Aged; Aged; Aphasia, Broca; Speech Production Measurement; Case-Control Studies; Semantics; Aged, 80 and over; Adult; Linguistics; Language Tests
PubMed: 38324346
DOI: 10.1044/2024_AJSLP-23-00165 -
Brain : a Journal of Neurology Feb 2024
Topics: Humans; Frontal Lobe; Aphasia, Broca
PubMed: 38302274
DOI: 10.1093/brain/awae003