SPECT findings in children with specific language impairment

Findings from 99mTc-HMPAO SPECT measurements at rest in a group of 19 school-age children with specific language impairment (SLI) were compared to a group of 12 children with attention-deficit hyperactivity disorder (ADHD). The regional cerebral blood flow (CBF) distributions were different in the two groups. Children with SLI showed significantly lower CBF values in the right parietal region and in the subcortical region compared to the ADHD group. In addition, the SLI group had symmetric CBF distributions in the left and right temporal regions, whereas the ADHD group showed the usual asymmetry with left-sided hemispheric predominance in the temporal regions. The findings give further evidence for anomalous neurodevelopment with deviant hemispheric lateralization as an important factor in the aetiology of SLI. They also point to the role of subcortical structures in language impairment in childhood. Earlier focus on cortical structures in SLI research needs to be widened to include subcortical regions as well.     

Chronological changes of MRI findings on striatal damage after acute cyanide intoxication: Pathogenesis of the damage and its selectivity,and prevention for neurological sequelae: A case report

Summary A 31-year-old male technician in an electroplating factory, who had been suffering from the temporal lobe epilepsy for 24 years and from hypertension for 3 years, took an unknown amount of potassium cyanide apparently over the lethal dose, in an attempt to commit suicide. He was treated successfully and survived without any neurological sequelae. The electroencephalograms and the nature of the seizures were not different before and after the poisoning. The T2-weighted magnetic resonance images at 9 and 51 days after the poisoning showed bilateral elevation of signals in the caudate nuclei and the putamina. At the 143th and 286th days, T2-weighted high-resonance areas were restricted to the lateral portion of the putamina. The T1-weighted images at the 51st day showed abnormal signal elevations in both putamina, while those of 9th, 143th and 286th days were mainly normal. Selective vulnerability of the putamen and the caudate nucleus may be due to their specific structural properties of high oxygen and glucose utilization, and enzyme distribution. Both chronological changes of striatal damage and the absence of neurological sequelae in this patient suggest the possibility that anti-epileptics and a calcium antagonist played a neuroprotective role in the acute cyanide intoxication.     

Impaired L1 and executive control after left basal ganglia damage in a bilingual Basque–Spanish person with aphasia

Bilinguals must focus their attention to control competing languages. In bilingual aphasia, damage to the fronto-subcortical loop may lead to pathological language switching and mixing and the attrition of the more automatic language (usually L1). We present the case of JZ, a bilingual Basque–Spanish 53-year-old man who, after haematoma in the left basal ganglia, presented with executive deficits and aphasia, characterised by more impaired language processing in Basque, his L1. Assessment with the Bilingual Aphasia Test revealed impaired spontaneous and automatic speech production and speech rate in L1, as well as impaired L2-to-L1 sentence translation. Later observation led to the assessment of verbal and non-verbal executive control, which allowed JZ's impaired performance on language tasks to be related to executive dysfunction. In line with previous research, we report the significant attrition of L1 following damage to the left basal ganglia, reported for the first time in a Basque–Spanish bilingual. Implications for models of declarative and procedural memory are discussed.     

Obstetric complications and neurological abnormalities in neuroleptic-naive psychotic patients

Studies addressing the relationship between a history of obstetric complications (OCs) and neurological abnormalities in schizophrenia have produced contradictory findings. Using a pre-posttreatment design in a neuroleptic-naive sample of psychotic patients, we examined the relationship of a history of OC to primary and drug-induced neurological signs. Fifty neuroleptic-naive non-affective psychotic inpatients were assessed for a history of OC by using the McNeil-Sjöström scale, and for neurological signs including parkinsonism, dyskinesia, akathisia and catatonia, which were rated before and after inception of neuroleptic treatment. A subsample of 28 patients were also examined for neurological soft-signs. Ratings of OCs were related to admission levels of parkinsonism, dyskinesia, akathisia and neurological soft-signs, but not to levels of catatonia. By obstetric period, pregnancy complications were related to levels of parkinsonism, dyskinesia, and neurological soft-signs, and neonatal complications were related to levels of akathisia. Drug-induced neurological signs were not associated with a history of OCs. We argue that the association pattern between a history of OCs and primary neurological signs from several domains suggests a causal link among these variables. Having a history of OCs does not convey a vulnerability for developing drug-induced neurological signs in the short term.     

Non-credible language deficits following mild traumatic brain injury

Identification of non-credible memory and other cognitive symptoms has received widespread attention within the past two decades. However, minimal information is available regarding patterns of non-credible language symptoms. We present the case of a 36-year-old female civil litigant who displayed delayed onset, severe, relatively focal speech and language symptoms, including difficulties with articulation, dysfluent speech, expressive language impairments with minor receptive difficulties, and lack of prosody, subsequent to a minor head trauma. On neuropsychological evaluation 3 years post injury, the patient presented with the same speech/language characteristics, but additionally exhibited a vague “foreign accent.” Cognitive scores generally were normal with the exception of poor performance on many language tasks and processing/motor speed. The patient showed passing performance on most measures of response bias, but she failed effort indicators requiring rapid letter discrimination (b Test), rapid verbal repetition (timed forward digit span), and sensory function (finger agnosia errors) while passing effort indicators falling within the domains of memory, math/number skills, visuo-constructional ability, and attention. Thus, the type of failed effort indicators predicted the categories of standard cognitive tests on which she underperformed. Personality testing revealed patterns generally consistent with hysterical personality orientation. Given her long-standing history of multiple unexplained medical symptoms, the patient was diagnosed with a somatization disorder, as well as a current conversion disorder involving language symptoms. However, given her compensation-seeking status, the possibility of additional conscious feigning of symptoms could not be ruled out. The need for validation of additional measures to detect feigned language impairment is recommended.      

Constraint induced language therapy in early aphasia rehabilitation

Background: Constraint induced language therapy (CILT) focuses on improving acquired expressive language deficits after stroke by applying intensive, use-dependent treatment with constraint to spoken verbal expression. Most CILT research has utilised individuals with chronic aphasia, and previous results indicated improvement on the language assessments after intervention that was largely retained at follow-up.

Aims: The purpose of this study was to explore the applicability and outcome of a programme of CILT in individuals in the early phase of recovery from aphasia (1–2 months post onset) in an inpatient rehabilitation hospital setting.

Methods & Procedures: A 10-day/3 hours a day pre–posttest CILT intervention case series was carried out 1–2 months post onset with three Norwegian rehabilitation inpatients with aphasia following left CVA. Procedures involved card activities using high- and low-frequency picture stimuli with communicative relevance at four levels of complexity, either in a small group or one-to-one with a trained SLP.

Outcomes & Results: Results suggested an overall improvement on the language assessments post CILT intervention, as well as at the follow-up. A greater degree of improvement in performance on expressive speech tasks compared to receptive and written tasks suggested a treatment-specific effect of CILT for early aphasia rehabilitation. Participant evaluation of the CILT intervention reflected positive feedback for the treatment experience and satisfaction with individual gains. Challenges in the application of CILT to this phase of recovery were the need to accommodate the demands of the inpatient rehabilitation setting and the decreased stamina of the participants.

Conclusions: The results of this study support the applicability of CILT in early aphasia rehabilitation, with some modifications of the original protocol.     

Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit

Abstract Objective To determine independent clinical predictors of stroke-associated pneumonia (SAP) that are available in all patients on day of hospital admission. Methods We studied 236 patients with acute ischemic stroke admitted to the neurological intensive care unit at our university hospital. Risk factors of SAP and of non-responsivity of early-onset pneumonia (EOP; onset within 72 hours after admission) to initial antibacterial treatment were analyzed. Results Incidence of SAP was 22%. The following independent risk factors were found to predict SAP with 76% (EOP: 90%) sensitivity and 88% specificity: dysphagia (RR, 9.92; 95% CI, 5.28-18.7), National Institute of Health Stroke Scale ≥ 10 (RR, 6.57; CI, 3.36-12.9), non-lacunar basal-ganglia infarction (RR, 3.10; CI, 1.17-5.62), and any other infection present on admission (RR, 3.78; CI, 2.45-5.83). Excluding the patients with other infections on admission, the same independent risk factors (except infection) were found. Further, but not independent risk factors were: combined brainstem and cerebellar infarction, infarction affecting more than 66% of middle cerebral artery territory, hemispheric infarction exceeding middle cerebral artery territory, impaired vigilance, mechanical ventilation, age ≥ 73 years, current malignoma, and cardioembolic stroke, whereas patients with lacunar infarctions had significantly lower risk. In contrast to previous reports, no impact of male gender or diabetes was found. Initial vomiting, especially if associated with impaired vigilance, predicted antibacterial treatment non-responsivity of EOP. In nonresponders exclusively fungal pathogens were identified. Conclusion Increased risk of pneumonia in acute stroke patients can be sufficiently predicted by a small set of clinical risk factors.     

基底节区进展性脑梗死侧支循环形成及其对近期神经功能缺失的影响

目的探讨基底节区进展性脑梗死脑侧支循环形成及其对近期神经功能缺失的影响。方法将该院收治的200例基底节区进展性脑梗死患者作为研究对象,在其入院后均采用头部CT血管造影(CTA)评估患者侧支循环建立情况,根据患者是否建立侧支循环将其分为侧支循环建立组和无侧支循环建立组,并以美国国立卫生研究院卒中量表(NIHSS)评估其入院时、卒中进展时和侧支循环建立后的神经功能缺损情况,探讨不同分级侧支循环、不同侧支循环开放类型的脑梗死患者神经功能缺失情况。结果 200例基底节区进展性脑梗死患者中有146例患者成功建立侧支循环,54例患者无侧支循环建立。侧支循环建立组在入院时和卒中进展时的NIHSS评分与无侧支循环建立组比较,差异均不显著(P 0.05);治疗2周时NIHSS评分低于无侧支循环建立组(P 0.05)。3～4级侧支循环患者在入院时和卒中进展时的NIHSS评分与1～2级侧支循环患者比较,差异均不显著(P 0.05);治疗2周时NIHSS评分低于1～2级侧支循环患者(P 0.05)。前循环脑梗死患者侧支循环建立数多于后循环脑梗死患者(P 0.05)。前循环脑梗死患者入院时和卒中进展时的NIHSS评分与后循环脑梗死患者比较,差异均不显著(P 0.05);治疗2周时NIHSS评分低于后循环脑梗死患者(P 0.05)。结论脑侧支循环形成可改善基底节区进展性脑梗死患者近期神经功能缺失情况。     

Recovery of language function in Korean-Japanese crossed bilingual aphasia following right basal ganglia hemorrhage

ABSTRACT

Few studies have investigated language recovery patterns and the mechanisms of crossed bilingual aphasia following a subcortical stroke. In particular, Korean-Japanese crossed bilingual aphasia has not been reported. A 47-year-old, right-handed man was diagnosed with an extensive right basal ganglia hemorrhage. He was bilingual, fluent in both Korean and Japanese. After his stroke, the patient presented with crossed aphasia. We investigated changes in the Korean (L1) and Japanese (L2) language recovery patterns. Both Korean and Japanese versions of the Western Aphasia Battery (WAB) were completed one month after the stroke, and functional magnetic resonance imaging (fMRI) was performed using picture-naming tasks. The WAB showed a paradoxical pattern of bilingual aphasia, with an aphasia quotient (AQ) of 32 for Korean and 50.6 for Japanese, with Broca’s aphasia. The patient scored better in the Japanese version of all domains of the tests. The fMRI study showed left lateralized activation in both language tasks, especially in the inferior frontal gyrus. After six months of language therapy targeting L1, the Korean-WAB score improved significantly, while the Japanese-WAB score showed slight improvement. In this case, the subcortical lesion contributed to crossed bilingual aphasia more highly affecting L1 due to loss of the cortico-subcortical control mechanism in the dominant hemisphere. The paradoxical pattern of bilingual aphasia disappeared after lengthy language therapy targeting L1, and the therapy effect did not transfer to L2. Language recovery in L1 might have been accomplished by reintegrating language networks, including the contralesional language homologue area in the left hemisphere.     

Effects of intrastriatal cannabinoids on rotational behavior in rats: Interactions with the dopaminergic system

The effect of unilateral intrastriatal cannabinoid receptor stimulation on rotational behavior in rats was explored. The potent cannabinoid agonist CP 55,940 (5 μg/0.5 μl) induced contralateral turning when microinjected unilaterally into the striatum. The D₂dopamine agonist quinpirole reversed this contralateral rotation but failed to affect motor behavior on its own. Finally, the D₁dopamine agonist SKF 82958 inhibited movement when administered into the striatum and this inhibition was reversed by co-administration of the cannabinoid agonist. Surprisingly, microinjections of the cannabinoid agonist into the striatum induced movement through activation of the striatonigral pathway and/or inhibition of the striatopallidal pathway, while the D₁dopamine agonist produced the opposite effect. Synapse 30:221–226, 1998. © 1998 Wiley-Liss, Inc.     

Neural dissociation in the production of lexical versus classifier signs in ASL: distinct patterns of hemispheric asymmetry

We examine the hemispheric organization for the production of two classes of ASL signs, lexical signs and classifier signs. Previous work has found strong left hemisphere dominance for the production of lexical signs, but several authors have speculated that classifier signs may involve the right hemisphere to a greater degree because they can represent spatial information in a topographic, non-categorical manner. Twenty-one unilaterally brain damaged signers (13 left hemisphere damaged, 8 right hemisphere damaged) were presented with a story narration task designed to elicit both lexical and classifier signs. Relative frequencies of the two types of errors were tabulated. Left hemisphere damaged signers produced significantly more lexical errors than did right hemisphere damaged signers, whereas the reverse pattern held for classifier signs. Our findings argue for different patterns of hemispheric asymmetry for these two classes of ASL signs. We suggest that the requirement to encode analogue spatial information in the production of classifier signs results in the increased involvement of the right hemisphere systems.     

Effects of intrapallidal cannabinoids on rotational behavior in rats: Interactions with the dopaminergic system

The effect of unilateral intrapallidal cannabinoid receptor stimulation on rotational behavior in rats was explored. The potent cannabinoid agonist CP55,940 (5 μg/0.5 μl) induced ipsilateral turning when microinjected unilaterally into the globus pallidus. The D₂ dopamine agonist quinpirole reversed this ipsilateral rotation but failed to affect motor behavior on its own. Finally, the D₁ dopamine agonist SKF 82958 inhibited movement when administered into the globus pallidus, and this effect was not additive with CP55,940. Synapse 28:27–32, 1998. © 1998 Wiley-Liss, Inc.     

The effect of theory of mind impairment on language: Referring after right-hemisphere damage

Background: Some patients after right-hemisphere damage show difficulty in Theory of Mind (TOM) tasks, namely, in the ability to attribute and reason about mental states of others and of themselves.

Aims: We explored how such TOM impairment (aTOMia) following brain damage affects language abilities that are related to TOM. Specifically, we explored the ability of individuals with aTOMia to use and comprehend various referring expressions (e.g., definite and indefinite noun phrases, proper names, and pronouns) according to the speaker’s assessment of the addressee’s knowledge state about the referent.

Methods & Procedures: We compared linguistic abilities that depend on the evaluation of shared knowledge, and hence might be affected by TOM impairment, to purely syntactic tasks, unrelated to TOM. TOM-related abilities were assessed using 6 tasks that test the comprehension, production, and judgment of various types of referring expressions. Non-TOM, syntactic, abilities were assessed using 4 tasks of comprehension and production.

The participants were 21 Hebrew speakers with right-hemisphere damage aged 25–65 years (mean 52;2), 6 women and 15 men. Twenty of them had a right cerebrovascular accident, and one patient was surgically treated for the removal of a tumour. Fourteen of them were aTOMic, whereas 7 showed normal TOM. We compared the TOM-dependent linguistic abilities of the aTOMic patients to the brain-damaged patients with normal TOM, and to an age-matched control group.

Outcomes & Results: The participants with aTOMia performed consistently worse on the TOM-related linguistic tasks than the right-hemisphere-damaged participants with intact-TOM and the healthy control group. They failed to take into account the mental state of the interlocutors and the knowledge that they share in selecting a referring expression. In contrast, their syntactic abilities, which are not dependent on TOM, were intact. Their comprehension of relative clauses, Wh-questions, and object pronouns was normal, and their production of embedded sentences was similar to the controls. The aTOMic and non-aTOMic participants performed similarly to controls on the TOM-independent syntactic tasks.

Conclusions: Individuals who have aTOMia following right-hemisphere damage might show specific impairments in language, when the comprehension and production require TOM. An important implication of this study is, thus, that although these individuals do not suffer damage to the language areas in the brain, they should be considered for language evaluation and treatment.     

Lesion analysis of language production deficits in aphasia

Background: Three aspects of language production are impaired to different degrees in individuals with post-stroke aphasia: ability to repeat words and nonwords, name pictures, and produce sentences. These impairments often persist into the chronic stages, and the neuroanatomical distribution of lesions associated with chronicity of each of these impairments is incompletely understood.

Aims: The primary objective of this study was to investigate the lesion correlates of picture naming, sentence production, and nonword repetition deficits in the same participant group because most prior lesion studies have mapped single language impairments. The broader goal of this study was to investigate the extent and degree of overlap and uniqueness among lesions resulting in these deficits in order to advance the current understanding of functional subdivision of neuroanatomical regions involved in language production.

Methods & Procedures: In this study, lesion-symptom mapping was used to determine if specific cortical regions are associated with nonword repetition, picture naming, and sentence production scores. Structural brain images and behavioural performance of 31 individuals with post-stroke left hemisphere lesions and a diagnosis of aphasia were used in the lesion analysis.

Outcomes & Results: Each impairment was associated with mostly unique, but a few shared lesions. Overall, sentence and repetition deficits were associated with left anterior perisylvian lesions, including the pars opercularis and triangularis of the inferior frontal lobe, anterior superior temporal gyrus, anterior portions of the supramarginal gyrus, the putamen, and anterior portions of the insula. In contrast, impaired picture naming was associated with posterior perisylvian lesions including major portions of the inferior parietal lobe and middle temporal gyrus. The distribution of lesions in the insula was consistent with this antero-posterior perisylvian gradient. Significant voxels in the posterior planum temporale were associated with a combination of all three deficits.

Conclusions: These findings emphasise the participation of each perisylvian region in multiple linguistic functions, suggesting a many(functions)-to-many(networks) framework while also identifying functional subdivisions within each region.     

早期使用丁苯酞注射液治疗基底节区脑梗死对侧支循环建立及神经功能的影响

目的探讨早期使用丁苯酞注射液治疗基底节区脑梗死对侧支循环建立及神经功能的影响。方法根据治疗方法将121例基底节区脑梗死患者分为丁苯酞组53例和对照组68例。两组患者给予脱水剂,胃黏膜保护剂、抗血小板聚集药、调脂药、扩血管药、活血化瘀中药、脑保护药物及其他对症支持治疗,丁苯酞组于发病24 h内加用丁苯酞注射液100 ml,静脉滴注2次/d。于入院第4~5 d采用CTA检查观察所有患者侧支循环的建立情况。于入院时、第2周及第3个月进行NIHSS评分。结果丁苯酞组37例(69.8%)建立侧支循环,对照组38例(55.9%)建立侧支循环。丁苯酞组侧支循环建立率显著高于对照组(P0.05)。丁苯酞组及对照组入院时NIHSS评分差异无统计学意义(P0.05)。与丁苯酞组比较,对照组第2周及第3个月NIHSS评分显著升高(P0.05~0.01)。结论早期使用丁苯酞注射液治疗的基底节区脑梗死患者可促进脑梗死部位的侧支循环的建立,减轻脑梗死症状,改善预后。