基底节性失语32例临床分析

丘脑或基底节内囊区病变引起的失语称为皮质下失语，近代研究对丘脑的复杂结构和生理功能有了一定的了解，肯定了丘脑参与语言这一复杂的高级心理活动，而基底节性失语是皮质下结构本身的病变所致，还是急性深部病变的“远隔效应”所引起，仍有争论。现将我科1998年6月～2000年6月收治的32例基底节内囊病变所致失语情况报告如下。     

老年人脑卒中后失语特点

目的：探讨老年人脑卒中后失语的特点。方法：收集８３例脑卒中后失语的患者,按汉语失语检查法（ＡＢＣ）确定失语类型分析其失语类型与年龄及失语严重程度与年龄的关系。结果：后部失语患者４６例,年龄在６０岁以上占３０例,其发生率高于５９岁以下（Ｐ〈０．０１）。失语重度组与轻度组的平均年龄组相比较有高度显著性差异（Ｐ〈０．００５）。结论：老年人脑卒中后失语多表现为后部失语的特点,其失语程度较年龄患者更重。     

早期启动言语记忆痕迹对脑卒中表达性和接受性失语患者疗效的影响

目的探讨早期启动言语记忆痕迹对脑卒中表达性和接受性失语患者语言康复效果的影响。方法100例脑卒中失语患者随机分为观察组和对照组,每组50例。对照组患者进行传统的语言康复训练。观察组在传统语言康复训练基础上,医护人员对每个患者的不同语言痕迹进行加强语言启动训练。结果60d内,观察组显效30例,有效13例,无效7例,总有效率86%;对照组显效22例,有效7例,无效21例,总有效率58%。2组比较有显著差异(P<0.01)。结论早期启动言语记忆痕迹在脑卒中失语患者康复训练中作用肯定,值得推广。     

脑卒中失语的康复护理体会

目的 探讨语言康复训练对脑卒中失语的疗效.方法 对26例脑卒中失语病人进行规范训练,在治疗前后运用改良波士顿诊断性失语症检查方法(BDAE)评估其语言功能.评估标准提高Ⅱ度者为明显好转,Ⅰ度者为好转,并进行比较.结果 运动性失语的Ⅱ度以上病人经3～4周训练后,明显好转的11例,好转2例.感觉性失语的8例病人经6～7周训练后明显好转5例,好转3例,总有效率达100%.但完全性失语的病人,康复效果较差,其中仍有2例经康复训练后仍无明显改善.结论 进行语言康复训练对脑卒中语言功能的恢复有积极疗效.     

多奈哌齐对脑卒中后失语的治疗效果评价

目的探讨多奈哌齐治疗脑卒中后失语的疗效和安全性。方法脑卒中后失语患者随机分为对照组(38例)及治疗组(38例)。对照组给予常规治疗,治疗组在常规治疗的基础上给予多奈哌齐5 mg,1次/d,共4周。采用西方成套测验(WAB)并计算失语商(AQ)评定患者语言功能。结果治疗后,两组的WAB、AQ评分均有所提高,但治疗组WAB中的口语表达、听理解、复述等方面评分与对照组相比明显增高,差异有统计学意义(P<0.05)。多奈哌齐对运动性失语、感觉性及传导性失语中的复述言语障碍改善作用明显,但对命名性失语无明显疗效。未见明显药物不良反应。结论多奈哌齐治疗脑卒中后失语有效且较安全。     

脑卒中失语患者早期康复训练的效果观察

目的 探讨脑卒中失语患者早期康复训练的效果.方法 对130例脑卒中失语患者按床位的单、双号随机分为观察组和对照组,采用汉语失语检查表[1]进行评定记分. 结果 2组患者出院和随访时语言表达能力均有改善(P＜0.05),但观察组改善的幅度较大. 结论 观察组的疗效优于康复组,但康复组也有一定疗效.     

非语言沟通在脑卒中失语患者中的应用体会

现代医学模式中，护患交往在医、护、患三者之间的作用日益显现，它不仅影响护患之间的行为态度，也直接影响到治疗护理工作的态度。而非语言沟通在医疗护理中有其特殊的重要性，特别是在脑卒中失语患者中，因为病人及其家属对医务人员的非语言沟通通常给予密切关注。同样，医务人员在很大程度上依赖于病人非语言沟通来完成与病人的交流。笔者在临床护理工作中运用非语言沟通技巧改善了护患关系，提高了护理质量。     

急性脑梗死导致特殊类型失语临床分析

目的观察急性脑梗死所致几种特殊类型失语症患者的语言特点。方法分别在发病1 w、4 w采用中国康复研究中心的汉语标准失语症检查表对遴选患者进行评价,并完善留存影像学资料。其中包括1例纯词哑、2例交叉性失语、1例基底节性失语及1例丘脑性失语。结果少数急性脑梗死患者失语症类型、神经影像学检查所见的病变部位并不完全符合经典的失语症模式。结论经典语言中枢以外的更多部位可能参与失语症的形成。     

Prevalence of anxiety in people with aphasia after stroke

Background: Anxiety is common after stroke and is associated with poorer recovery. People with aphasia after stroke are typically excluded from studies of anxiety prevalence and so the number of those affected is unclear.

Aims: To make a preliminary estimate of the prevalence of significant anxiety in people with aphasia after stroke.

Methods & Procedures: Carers to community-dwelling people with aphasia after stroke, N = 111, completed the Behavioural Outcomes of Anxiety scale (BOA), a modified Hospital Anxiety and Depression Scale – Anxiety sub-scale (HADS-A), and a modified Generalised Anxiety Disorder-7 item (GAD-7) scale to determine the presence of significant anxiety in the person for whom they cared. Associates of anxiety in people with aphasia after stroke were also investigated.

Outcomes & Results: The BOA identified 49 people (44%) as having significant anxiety. Findings for the HADS-A = 46 (41%) were similar; however, for the GAD-7, the rate was substantially lower = 18 (16%). Anxiety after stroke had a modest but significant association with younger age (all measures) and with the Frenchay Aphasia Severity Test scores (BOA and HADS-A only).

Conclusions: The prevalence of anxiety in people with aphasia after stroke is high and likely higher than in those with stroke with no aphasia when measured using a validated tool for this population. Risk factors for anxiety appear to be severity of aphasia and younger age. This finding should be tempered by the fact that this is a preliminary study in a relatively small sample consisting of those attending stroke groups and the use of caregiver assessments may overestimate the prevalence of mood disorder.     

Characteristics of basal ganglia aphasia after stroke and the rehabilitative interventions

To introduce the characteristics of basal ganglia aphasia after stroke and the rehabilitative interventions.DATA SOURCES: Articles related to stroke, subcortical aphasia, basal ganglia aphasia and language rehabilitation published in Chinese from January 1988 to December 2005 were searched in Chinese journal full-text database (CJFD) using the keywords of“stroke, basal ganglia aphasia, language rehabilitation“ in Chinese. Meanwhile, English articles about aphasia published from January 1982 to December 2005 were searched in and Pubmed database. Besides, several books associated with the contents were looked through manually.STUDY SELECTION: The data were checked primarily, the articles about the pathomechanism and neurolinguistic characteristics of basal ganglia aphasia, diagnostic methods of aphasia and language rehabilitation were selected, and those had no obvious relation with the above contents were excluded.Inclusive criteria: literatures explain the clinical characteristics of basal ganglia aphasia, neurolinguistic pathogenesis and methods of rehabilitation therapy in details. The repetitive studies were excluded.DATA EXTRACTION: Totally 95 literatures about basal ganglia aphasia were collected, including 31 about the clinical characteristics of basal ganglia aphasia, 45 about its neurolinguistic pathogenesis, 5 about the evaluation and classification of aphasia, and 14 about its rehabilitation therapy. Thirty accorded with the inclusive criteria were used for review, and the other 65 were excluded.DATA SYNTHESIS: Concisely introduced the definition, past investigation of basal ganglia aphasia after stroke, then dwelled on the multiplicity neurolinguistics characteristics. Aphasia evaluation was dependent upon clinical aphasic symptoms. The relationship between symptom and focus of infection was explored, and the mechanism of pathosis language behavior on basal ganglia aphasia patients was understood to provide consequence data that could authenticate the processing of language in brain. On the other hand, the method of rehabilitation on basal ganglia aphasia after stroke was explained.CONCLUSION: Basal ganglia aphasia is manifested as atypical aphasic symptom, the mechanism for the structure of basal ganglia in the speech formation should be further confirmed. It is effective to select pertinent language rehabilitation for basal ganglia aphasia after stroke.     

神经内镜与锁孔显微治疗基底节脑出血的疗效对比研究

目的分析神经内镜与锁孔显微治疗基底节脑出血患者的临床疗效及安全性。 方法选取南方医科大学顺德医院自2015年1月至2016年12月治疗的基底节脑出血患者62例。根据手术方案分为2组,内镜组（35例）采用神经内镜手术治疗,锁孔组（27例）采用锁孔显微手术治疗。比较2组患者手术用时、术中失血量、血肿清除率、住院时间等手术相关指标情况及并发症发生率,并对比术前、术后7 d GCS评分变化;术后6个月采用日常生活能力量表评估2组的预后情况。 结果内镜组手术用时、住院时间短于锁孔组,术中失血量少于锁孔组,血肿清除率高于锁孔组,差异有统计学意义（P<0.05）;内镜组并发症发生率低于锁孔组（5.71% vs. 29.63%）,差异有统计学意义（P<0.05）;术后7 d内镜组GCS评分等级优于锁孔组,差异有统计学意义（P<0.05）;术后6个月,内镜组预后效果优于锁孔组,差异有统计学意义（P<0.05）。 结论与锁孔显微手术相比,神经内镜治疗基底节脑出血可缩短手术用时、住院时间,减少术中失血量,提高血肿清除率及降低并发症发生率低。     

应用微机评估立体定向抽吸术治疗椎基底节区脑出血的疗效观察

目的研究应用微机评估预测立体定向抽吸术治疗基底节区脑出血的疗效的临床价值。方法 应用Bayas公式和最大隶属原则分析87例内样本,建立评估模型,并将内样本与36例外样本进行对比。结果 外样本病例术后生存率明显高于内样本.经统计学处理两者有显著性差异(P<0.05)。结论 临床上应用微机评估预测立体定向抽吸术治疗基底节区脑出血的疗效,对于选择适合手术病例有指导意义。     

Lobar vs thalamic and basal ganglion hemorrhage: clinical and radiographic features

Summary One hundred and twelve patients with spontaneous supratentorial intracerebral hemorrhages were reviewed to identify features which distinguish lobar intracerebral hemorrhage (LH; n=42) from thalamic or basal ganglionic hemorrhage (TGH; n=70). Chronic hypertension occurred more commonly in TGH (TGH 67%; LH 48%) while bleeding diathesis was more common in LH (LH 19%; TGH 6%). Clinical presentations were extremely variable and not associated with the type of hemorrhage. Bleeding into the ventricles and hydrocephalus occurred more often with TGH. At last follow-up, there were minimal differences between LH and TGH in overall mortality and functional outcome of the survivors. Alertness on admission was associated with a good outcome regardless of the type of hemorrhage, while a low Glasgow Coma Scale score, coma, ataxic respiration, abnormal pupil reactions, acute hypertension, large hemorrhage size and intraventricular blood were associated with a poor outcome. These data confirm etiological distinctions between LH and TGH, but fail to confirm previously reported differences in clinical presentation and outcome.     

Effects of different frequencies of repetitive transcranial magnetic stimulation in stroke patients with non-fluent aphasia: a randomized,sham-controlled study

Objective: The purpose of this study was to compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) applied at different frequencies to the contra-lesional hemisphere to optimize the treatment of post-stroke non-fluent aphasia.

Method: Patients with post-stroke non-fluent aphasia were divided randomly into four groups: a high-frequency rTMS (HF-rTMS) group (10 Hz), a low-frequency rTMS (LF-rTMS) group (1 Hz), a sham stimulation group, and a control group. All groups received the standard treatment (consisting of drug therapy, conventional physical exercises, and speech training); in the HF-rTMS and LF-rTMS, this was supplemented with magnetic stimulation that targeted the mirror area within the right hemispheric Broca’s area. Patients’ language ability was assessed prior to, immediately after, and at 2 months post-treatment by the Chinese version of the Western Aphasia Battery (WAB).

Results: When measured immediately post-treatment, as well as at 2 months post-treatment, the LF-rTMS group exhibited a more marked improvement than the HF-rTMS group in spontaneous speech, auditory comprehension, and aphasia quotients (AQ). Compared to the control group, the HF-rTMS cohort exhibited significant improvement at 2-months post-treatment in repetition and AQ.

Conclusions: LF-rTMS and HF-rTMS are both beneficial to the recovery of linguistic function in patients with post-stroke non-fluent aphasia. LF-rTMS produced immediate benefits that persisted long-term, while HF-rTMS only produced long-term benefits. In addition, the benefits produced with LF-rTMS were more marked than those produced by HF-rTMS.     

Prognosis of aphasia in stroke patients early after iv thrombolysis

Objective

Stroke patients with aphasia have a high long-term morbidity. Intravenous rt-PA (iv) thrombolysis is given more deliberately to these patients. Early outcome data is lacking. Aim of this study was to determine early benefit from rt-PA in patients with aphasia.

Methods

Data of stroke patients treated by iv thrombolysis was scrutinized for the presence of aphasia defined as ≥1 point for aphasia on the National Institute of Health Stroke Scale (NIHSS). Improvement was defined as a gain of ≥1 point within 24 h. Cranial computed tomography (CT) scans were evaluated regarding early ischemic changes (EICs), infarct volume and localization.

Results

Fifty patients with aphasia were included. 16 (32%) of patients improved (4 (36%) minor, 7 (41%) moderate, 5 (23%) major stroke patients), while 44 (62%) remained unchanged. Of 28 patients with EICs, 10 (36%) improved compared to 7 out of 22 (32%) patients without (p = 0.773). Aphasia outcome was significantly associated with infarct volume at admission and at 24 h (Kruskal–Wallis, p = 0.033, p ≤ 0.001, respectively).

Conclusion

EICs are not predictive of aphasia outcome and patients with improvement showed smaller infarct volumes. One third improved within 24 h, while two thirds remained unchanged. This might justify a closer follow-up of aphasia in stroke patients at the acute stage.     

Repetitive transcranial magnetic stimulation therapy for post-stroke non-fluent aphasia: A critical review

Objectives: To assess the efficacy of repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia through a review of current literature.

Methods: Three electronic databases (Medline, Embase & Scopus) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed.

Results: The literature search yielded 4713 studies. Thirty-five articles were further evaluated to be included. Thirteen met all inclusion criteria and were chosen for review. The studies provide moderate to strong evidence that rTMS may be an effective treatment for non-fluent stroke aphasia.

Conclusion: There are some strong studies evaluating the efficacy of rTMS in non-fluent stroke patients but further research is required to fully establish the usefulness of this treatment. Future directions and limitations are presented.