Early prediction of aphasia outcome in left basal ganglia hemorrhage

OBJECTIVES: The independent predictors of aphasia outcome for patients with left basal ganglia hemorrhage were evaluated. PATIENTS AND METHODS: We included 140 patients of 1,036 patients with spontaneous intracerebral hemorrhage admitted to our hospital from January 1993 through December 1997. Aphasia was assessed using the aphasia scale of the Scandinavian stroke scale. Univariate and step-wise logistic regression analyses were performed to assess the relationships between the initial aphasia score, age, gender, blood volume, locations of hematoma and aphasia outcome. RESULTS: Step-wise logistic regression analysis revealed that the following two factors were independently associated with the final aphasia outcome: initial aphasia score (P < 0.0001) and location of hematoma involving the posterior limb of the internal capsule (P = 0.004). CONCLUSIONS: A particularly high likelihood of poor aphasia outcomes of patients with left basal ganglia hemorrhage are predicted in those who have poor initial aphasia score and whose brain computed tomography shows the hematoma involves the posterior limb of the internal capsule.     

Recovery of function and basal ganglia [14C]2-deoxyglucose uptake after nigrostriatal injury

Rats with unilateral 6-hydroxydopamine injections along the mesotelencephalic dopaminergic projection showed a profound impairment in localizing somatosensory stimuli on the contralateral body surface at 3 days postoperatively. Approximately one-half of the affected animals recovered the ability to localize tactile stimuli during 6 weeks postoperatively, whereas the remainder did not. When it occurred, the recovery of sensorimotor function began between the third and fifth day postoperatively and plateaued between days 14 and 21. Unilateral damage to these dopaminergic neurons resulted in hemispheric asymmetries of [14C]2-deoxyglucose incorporation at 3 days postoperatively. For structures that normally receive a dopaminergic innervation (e.g., neostriatum, nucleus accumbens septi, olfactory tubercle) the autoradiographic density of the injured side was decreased relative to the intact hemisphere. For structures that receive striatal inputs (globus pallidus, entopeduncular nucleus, substantia nigra pars reticulata), the autoradiographic density was increased on the side of the injury. This pattern of altered [14C]2-deoxyglucose incorporation was still present at 6 weeks postoperatively in animals that showed no recovery of somatosensory localization during that time. In contrast, rats that did recover showed no hemispheric asymmetries within the anterior neostriatum, globus pallidus, or substantia nigra pars reticulata at 6 weeks postoperatively, and the time course of normalization of metabolic activity in these structures was similar to that for behavioral restoration. These results directly demonstrate the importance of the neostriatum and particular structures efferent to it in the recovery of sensorimotor functions after striatal dopamine depletion. The types of neuronal plasticity within this basal ganglia circuitry responsible for the normalization of [14C]2-deoxyglucose incorporation and behavior are discussed.     

Executive function and conversational strategies in bilingual aphasia

Background: Deficits of executive function (EF) have been proposed as all or part of the underlying mechanisms of language impairment in at least some types of aphasia. Executive functions also play a role in the recovery process. There is evidence that bilingual persons have some executive functioning advantages compared to monolingual persons. In this paper we combine two lines of recent investigation in order to explore the relationship between executive function and conversational strategies in bilingual aphasia.

Aims: The aim of this preliminary research was to compare the executive functioning profiles of bilingual individuals to those of monolingual participants with aphasia. A further aim was to examine evidence in the conversational samples of the participants in relation to the application of a range of executive skills and to link cognitive and conversational profiles using Barkley's (1997) model of executive functions.

Methods & Procedures: The performance of two bilingual individuals with aphasia on a test battery of executive function tests was compared with that of eight monolingual persons (seven with aphasia and one with right hemisphere damage). The test battery included measures of behavioural inhibition, working memory, problem solving, and reconstitution. The presence or absence of executive features in the conversational samples of the participants was judged by four raters using conversational analysis methods.

Outcomes & Results: Significant differences were found between the scores of the bilingual participants and those of the monolingual participants on measures of behavioural inhibition, working memory, planning and problem solving, and reconstitution. The bilingual participants' scores were mostly within normal limits and suggested well‐retained executive functions. Conversation analysis showed evidence of differential application of these executive functions to conversational management. Regardless of severity or type of aphasia, the bilingual participants showed evidence of good topic management, repair, and flexibility compared to the monolingual participants.

Conclusions: The results are interpreted in relation to current issues in bilingualism. Our preliminary findings shed light on differential approaches to assessment, therapy, and choice of language for bilingual aphasia.     

Recovery of language function and brain metabolism in a patient with crossed aphasia: 2-year follow-up of brain FDG PET images

Background: Crossed aphasia, a language disturbance in right-handed individuals secondary to a right hemisphere lesion, is rare, occurring in only l-2% of brain-lesioned patients. The precise neurological mechanisms of crossed aphasia are still unknown, and follow-up studies in the long term of language function are sparse.

Aims: We describe a detailed follow-up evaluation of language function and resting brain glucose metabolism in a well-defined crossed aphasia patient after right middle cerebral artery (MCA) infarction.

Methods & Procedures: A 49-year-old man was referred for the treatment of 3-week history of aphasia after right MCA infarction. He indicated a strong right-handed preference confirmed by the Edinburgh Handedness Questionnaire, and his family members are all right handed. There was no history of developmental delay or learning disability in childhood or previous neurological disease. Formal language evaluation was carried out in the subacute phase (3 weeks after onset) and the late phase (5 and 24 months after onset) with the Korean version of Western Aphasia Battery. He received 40-min sessions of conventional speech and language therapy by a qualified therapist of comparable experience, three times a week. The serial F-18 fluorodeoxyglucose positron emission tomography (FDG PET) scan was performed on 3 weeks and 24 months after onset, respectively. Subtraction PET imaging between baseline and follow-up evaluation was conducted with coregistration with the patient’s magnetic resonance imaging.

Outcomes & Results: In the initial evaluation, his aphasia was categorized as Broca’s aphasia [aphasia quotients (AQs) 50.4, language quotients (LQs) 49.8]. Four months after the initial evaluation, the function of spontaneous speech, repetition, naming, and reading significantly improved, with a relatively moderate progress of comprehension (AQ 83.5, LQ 78.1). At 2-year follow-up, the function of spontaneous speech, repetition, naming, reading, and writing improved, but the comprehension revealed impairment with minimal improvement (AQ 88.9, LQ 86.8). The result revealed that the 20% increased area of F-18 FDG uptake in the subtraction PET image corresponded to the right basal ganglia, the right medial temporal lobe, both occipital lobes, and the left cerebellum.

Conclusions: Our case showed long-term recovery of brain glucose metabolism and language function in a patient with mirror image crossed aphasia. The restoration of perilesional brain function and diaschisis possibly contributed to the recovery of the crossed aphasia.     

A case of crossed aphasia with apraxia of speech

Apraxia of speech (AOS) is a rare, but well-defined motor speech disorder. It is characterized by irregular articulatory errors, attempts of self-correction and persistent prosodic abnormalities. Similar to aphasia, AOS is also localized to the dominant cerebral hemisphere. We report a case of Crossed Aphasia with AOS in a 48-year-old right-handed man due to an ischemic infarct in right cerebral hemisphere.     

Crosslinguistic semantic and translation priming in normal bilingual individuals and bilingual aphasia

The present study examined lexical representation in early Spanish‐English bilinguals using an unmasked semantic and translation priming paradigm. In Experiment 1, participants were divided into two groups based on performance (more‐balanced bilinguals, MB and less‐balanced bilinguals, LB) on the experimental task. In Experiment 2, four patients with bilingual aphasia (BA) performed the same experiment. Results from both experiments revealed that all groups were more accurate for English targets (S‐E direction) than Spanish targets (S‐E direction). In Experiment 1, semantic priming was observed from English to Spanish in both the LB and MB groups although the effect was greater for the LB group. Further, only the LB group showed priming from Spanish to English. For both normal groups, there was no difference between translation and semantic priming effects. In Experiment 2, patients with bilingual aphasia demonstrated different patterns of activation with no clear trends. Two participants demonstrated greater priming from Spanish to English whereas two participants demonstrated the opposite effect.     

基底节区脑出血临界体积下治疗方法的比较

目的 比较基底节区高血压脑出血临界体积(30 ±5)ml 以下的血肿非手术保守治疗、≤6 h 钻孔引流、6 ～48 h 钻孔引流的方法,分析3 种方式的优缺点.方法 对393 例出血性脑卒中患者,采用3 种不同的治疗方法,观察疗效.结果 术后3 个月随访,根据日常生活能力(ADL)分级法评定,≤6 h 钻孔引流组与保守组、6 ～48 h 内钻孔引流组均有显著性差异(P ＜0.05).保守治疗组与6 ～48 h 内钻孔引流组相比无显著性差异(P ＞0.05).保守治疗组与所有钻孔引流组相比无显著性差异(P ＞ 0.05).在住院天数、血肿消除时间、住院费用方面,钻孔引流组具有较大的优势.结论 基底节区高血压脑出血临界体积(30 ±5 )ml 以下的血肿保守治疗与钻孔引流在远期疗效方面无明显差异,但结合安全性、住院天数、血肿消除时间、住院费用等方面,我们认为6 ～48 h 内钻孔引流是治疗高血压脑出血的一个较好的方法.     

The functional connectivity of intralaminar thalamic nuclei in the human basal ganglia

Projections of the centromedian‐parafasicularis neurons of the intralaminar thalamus are major inputs of the striatum. Their functional role in the activity of human basal ganglia (BG) is not well known. The aim of this work was to study the functional connectivity of intralaminar thalamic nuclei with other BG by using the correlations of the BOLD signal recorded during “resting” and a motor task. Intralaminar nuclei showed a marked functional connectivity with all the tested BG, which was observed during “resting” and did not change with the motor task. As regards the intralaminar nuclei, BG connectivity was much lower for the medial dorsal nucleus (a thalamic nucleus bordering the intralaminar nuclei) and for the default mode network (although intralaminar nuclei showed a negative correlation with the default mode network). After the “regression” of intralaminar nuclei activity (partial correlation), the functional connectivity of the caudate and putamen nuclei with other BG decreased (but not with the primary sensorimotor cortex). Present data provide evidence that intralaminar nuclei are not only critical for striatal activity but also for the global performance of human BG, an action involving subcortical BG loops more than cortico‐subcortical loops. The high correlation found between BG suggest that, similarly to that reported in other brain centers, the very‐slow frequency fluctuations are relevant for the functional activity of these centers. Hum Brain Mapp 36:1335–1347, 2015. © 2014 Wiley Periodicals, Inc .     

翼点切口侧裂-岛叶入路治疗基底节脑出血

目的 探讨显微镜下经侧裂-岛叶清除基底节区脑内出血,脑组织及血管保护.方法 回顾性分析近两年经岛叶入路,显微镜下血肿清除术治疗29例基底节区脑出血患者临床资料.结果 术后1h、24 h、7d复查头颅CT,血肿清除率＞90％ 21例、＞80％8例,再出血1例.ADL评分Ⅰ级4例,Ⅱ级10例,Ⅲ级13例,Ⅳ级2例.结论 翼点经侧裂岛叶入路有利于保护神经和血管组织.     

简易经额定向穿刺术治疗高血压基底节区脑出血的研究

目的探讨简易经额定向穿刺术治疗高血压基底节区脑出血的效果。方法自2012年10月~2015年6月采用简易经额定向穿刺术治疗高血压基底节区脑出血患者37例,总结分析患者术前临床资料、术中情况及术后疗效。结果本组患者中合并脑疝7例(19%),超早期手术13例(35%);术中平均血肿抽吸率为32%(10%~65%),血肿部分抽吸后见脑皮质塌陷;术后并发症的发生率为22%,其中再出血率5%;术后30 d内的死亡率为0,术后6个月的预后良好率为92%(ADLⅠ~Ⅲ级)。结论简易经额定向穿刺术治疗高血压基底节区脑出血简单实用,适应证广,安全有效;而把握好手术时机和注重围手术期细节管理是疗效好的保障。     

三种微创手术方式治疗基底核区脑出血的效果比较

目的比较三种微创手术方法治疗基底核区脑出血的疗效、安全性和发生并发症的情况。方法根据手术方式不同,将107例基底核区脑出血病人分为内镜下血肿清除组(n=29)、立体定向血肿碎吸组(n=33)和小骨窗开颅显微手术组(n=45)。比较各组术前准备时间、手术时间和术中失血量。术后2d内复查CT,计算残余血肿量和血肿清除率。术后3个月按GOS预后评分评估治疗效果、病死率和手术并发症发生率。结果术前准备时间以定向组最长,达(146.1±57.0)min,与另外两组比较,差异有统计学意义(P<0.01);手术时间以开颅组最长,达(173.7±57.3)min(P<0.01);术中失血量以开颅组较多,达(293.3±166.6)ml(P<0.05);血肿清除率以内镜组最高,达(80.7±7.9)%(P<0.01);再出血和颅内感染发生率内镜组为10.3%,定向组为18.2%,开颅组为11.1%;病死率分别为0、9.1%、6.7%。GOS预后比较,Ⅱ级以上者在内镜组与定向组之间差异有统计学意义(P<0.05)。结论内镜辅助下血肿清除术既有创伤小,又有血肿清除彻底、止血可靠的优点,疗效确切,对不需行去大骨瓣减压的脑出血病人是一种较理想的微创手术方式。     

Distinct basal ganglia hyperechogenicity in idiopathic basal ganglia calcification

We report a 67‐year‐old patient with idiopathic basal ganglia calcification (IBGC). He presented with progressive cognitive impairment, frontal lobe dysfunction, mild leg spasticity, and levodopa (L ‐dopa)‐responsive parkinsonism. Transcranial sonography (TCS) revealed marked hyperechogenicity of the basal ganglia and periventricular spaces bilaterally. The detected signal alterations showed a fairly symmetric distribution and corresponded to the hyperintense calcifications depicted on the computer tomography brain scan. The combination of symmetric hyperechogenic areas adjacent to the lateral ventricles and of the basal ganglia may serve as an imaging marker characteristic of IBGC. Hyperechogenicity due to extended basal ganglia calcification as presented here is distinct from the pattern of hyperechogenicity caused by heavy metal accumulation, which is described to be less striking. In addition to atypical parkinsonian syndromes such as progressive supranuclear palsy and multiple system atrophy, IBGC is thus another differential diagnosis of parkinsonism with basal ganglia hyperechogenicity. © 2010 Movement Disorder Society.     

Recovery of function and basal ganglia [C]2-deoxyglucose uptake after nigrostriatal injury

Rats with unilateral 6-hydroxydopamine injections along the mesotelencephalic dopaminergic projection showed a profound impairment in localizing somatosensory stimuli on the contralateral body surface at 3 days postoperatively. Approximately one-half of the affected animals recovered the ability to localize tactile stimuli during 6 weeks postoperatively, whereas the remainder did not. When it occurred, the recovery of sensorimotor function began between the third and fifth day postoperatively and plateaued between days 14 and 21.Unilateral damage to these dopaminergic neurons resulted in hemispheric asymmetries of [¹⁴C]2-deoxyglucose incorporation at 3 days postoperatively. For structures that normally receive a dopaminergic innervation (e.g., neostriatum, nucleus accumbens septi, olfactory tubercle) the autoradiographic density of the injured side was decreased relative to the intact hemisphere. For structures that receive striatal inputs (globus pallidus, entopeduncular nucleus, substantia nigra pars reticulata), the autoradiographic density was increased on the side of the injury.This pattern of altered [¹⁴C]2-deoxyglucose incorporation was still present at 6 weeks postoperatively in animals that showed no recovery of somatosensory localization during that time. In contrast, rats that did recover showed no hemispheric asymmetries within the anterior neostriatum, globus pallidus, or substantia nigra pars reticulata at 6 weeks postoperatively, and the time course of normalization of metabolic activity in these structures was similar to that for behavioral restoration.These results directly demonstrate the importance of the neostriatum and particular structures efferent to it in the recovery of sensorimotor functions after striatal dopamine depletion. The types of neuronal plasticity within this basal ganglia circuitry responsible for the normalization of [¹⁴C]2-deoxyglucose incorporation and behavior are discussed.     

Dissociations in processing derivational morphology: the right basal ganglia involvement

In the neuropsychological literature, there is converging evidence for a dominant role of the left hemisphere in morphological processing. However, two right hemisphere patients were described with a clear dissociation between impaired derivational morphology and preserved inflectional processing. A recent fMRI experiment confirmed the involvement of right hemispheric areas in derivational processing and also suggested that the right basal ganglia contribute to deriving nouns from verbs. The present investigation was aimed at further demonstrating the role of the right hemisphere in derivational processing. Nine right brain damaged subjects were asked to perform different derivational tasks. Five out of nine subjects confirmed the previous data. They selectively failed only in deriving nouns from verbs (i.e. to observe-->observation), mostly substituting the derived noun with a frequent inflectional suffix of the verb paradigm (i.e. observed instead of observation). Lesion subtraction analysis revealed that the caudate nucleus and the corona radiata, are the subcortical structures associated with the morphological deficit. Anatomical commonalities were found between lesion site in these patients and activations in healthy subjects. An account of these results in terms of a distributed bi-hemispheric neural network in complex language tasks is offered.     

快速细孔微创钻颅置管引流治疗高血压基底节脑出血

目的探讨快速细孔微创钻颅置管引流术治疗高血压基底节脑出血(hypertensive basal ganglia hemorrhage,HBGH)的优点,并与传统开颅(conventional open craniotomy,COC)作对照研究。方法回顾性分析了589例高血压基底节脑出血病人的临床资料,其中430例应用快速细孔钻颅器钻颅置管引流清除血肿,159例行开颅手术血肿清除。结果穿刺组恢复良好者(ADLⅠⅡⅢ)306例(占88.44%),预后不良者(ADLⅣⅤ级)40例(占11.56%),死亡84例,(占19.53%)。开颅组恢复良好者(ADLⅠⅡⅢ级)50例(占49.02%),预后不良占(ADLⅣⅤ级)52例(占50.98%),死亡57例(占33.96%)。两组死亡率及恢复良好率相比具有统计学意义(P<0.05)。结论快速细孔钻颅置管引流术是一种安全有效、简易经济、微创可行的治疗高血压脑出血的方法。是治疗高血压基底节脑出血,挽救患者生命、提高生活质量的有效手段。     

汉语失语症测评软件在脑出血后失语评定中的应用

目的探讨中康法汉语标准失语症电脑软件测评系统(CRRCAE)在左侧基底节区脑出血患者语言功能评定及疗效观察中的应用价值。方法对24例左侧基底节区脑出血患者行微创手术治疗,术后行语言康复训练等治疗,并在术前、术后4 w,8 w应用CRRCAE(电脑版)行语言功能评定。结果治疗后与治疗前相比,CRRCAE测评系统各项评分均有明显提高,且随着时间的推移,患者的语言功能明显提高。结论CRRCAE电脑软件测评系统可用于评定脑出血患者语言恢复的程度和特点,能有效的鉴别其改善的程度,具有较好的临床应用价值。     

神经导航引导下硬通道多靶点治疗基底节高血压脑出血

目的探讨神经导航引导下硬通道多靶点治疗基底节区高血压脑出血的疗效。方法治疗组根据神经导航确定穿刺部位、角度及深度,应用硬通道多靶点技术微创治疗,对照组采用经外侧裂岛叶入路显微手术治疗,两组患者各40例,观察对比两组疗效差异。结果两组患者术后6小时血肿清除率、平均手术时间、3天后肺部感染发生率、1月后GOS评分等级差异均有统计学意义(P﹤0.05),术后48小时左右血肿清除率及再出血率差异不明显,无统计学意义(P﹥0.05)。结论神经导航引导下硬通道多靶点治疗基底节高血压脑出血可降低死亡率及术后肺部感染等并发症,疗效满意,值得临床推广应用。     

基底节内侧型高血压脑出血患者的手术时机研究

目的：研究基底节内侧型高血压脑出血患者的手术时机。方法回顾性分析2012‐01—2014‐03在我院进行手术治疗的42例基底节内侧型高血压脑出血患者的临床资料,然后将病人分为A、B、C3组,A组手术时机为＜7 h ,B组为7 h＜ T＜24 h ,C组为＞24 h ,研究不同手术时机对患者治疗效果的影响。结果3组脑血肿量、GCS评分相比,差异无统计学意义（P＞0.05）;3组神经功能缺损、ADL评分相比,差异有统计学意义（P＜0.05）;3组的病死率、总有效率与术后并发症发生率相比,差异有统计学意义（P＜0.05）。结论出血后7 h内是基底节内侧型高血压脑出血患者手术治疗的最佳时机,早期手术治疗可显著改善患者的神经功能,降低病死率与术后并发症的发生率,提高日常生活能力。     

The many faces of crossed aphasia in dextrals: report of nine cases and review of the literature

A substantial body of the aphasia literature has been devoted to the topic of crossed aphasia in dextrals (CAD) over the past century but still no theory exists that explains the anomalous organization of neurocognitive functions in this population. However, if strict selection criteria are applied only some cases of vascular CAD are reported in which the correlation between neurocognitive disturbances and the locus of the brain lesion is studied. This study describes nine new cases of vascular CAD who underwent in-depth neurolinguistic and neuropsychological investigations. Our analysis shows the semiological variability of CAD phenomena and the many faces of the lesion-behaviour relationships of this exceptional neurobiological condition.