Why only some post-stroke survivors can 'copy what I say'
(Medical University of South Carolina) Researchers at the Medical University of South Carolina (MUSC) and elsewhere report in Brain that the left lateral temporal cortex must be intact in stroke patients with aphasia if they are to have their speech entrained. In speech entrainment, stroke survivors practice fluent speech production by following along with another speaker. The efficacy of this experimental approach for certain patients with non-fluent aphasia will be assessed by an MUSC-led multi-site trial.
Goals of care discussions are frequently indicated after acute stroke. Many of these conversations happen without direct patient participation secondary to aphasia or encephalopathy.
The thalamus is related to language function, and some thalamic stroke cases can cause aphasia . However, most previous cases reporting thalamic damage-induced ipsilateral subcortical diaschisis and aphasia were hemorrhagic stroke [1,2]. Only a few left thalamus infarction cases showed cortical hypoperfusion concerned with the aphasia, but no single-photon emission computed tomography (SPECT) or thalamic nucleus data were available . Thus, aphasia pathology due to cortical hypoperfusion following thalamus infarction, especially with respect to thalamic nuclei, is still unknown.
Conclusions: We speculated that damages to the basal ganglia disrupted the cortico-subcortical circuits that facilitated the transhemispheric communications of language functions, resulting in decreased interhemispheric FC. Consequently, the intrahemispheric FC increased as a possible compensatory mechanism to restore the language functions. PMID: 31955634 [PubMed - as supplied by publisher]
Publication date: Available online 20 January 2020Source: NeuropsychologiaAuthor(s): Maria Dekhtyar, Swathi Kiran, Teresa GrayAbstractThe bilingual advantage proposes that bilingual individuals have enhanced cognitive control compared to their monolingual counterparts. Bilingualism has also been shown to contribute to cognitive reserve by offsetting the behavioral presentation of brain injury or neural degeneration. However, this effect has not been closely examined in individuals with post-stroke or post-TBI aphasia. Because bilingualism has been suggested as a factor of cognitive reserve, it may provide protective mechan...
An elderly woman with h/o stroke and aphasia seemed different to her daughter, and was pointing all over her body as if in pain.They called 911.She had a history of PCI to the circumflex and also of severe mitral regurgitation, status post bioprosthetic valve replacement. Also a h/o LV aneurysm with thrombus, on anticoagulation, as well as a dual chamber pacemaker. On arrival, the BP was 60/30.Here is the initial ECG:There is atrial pacing and Right Bundle Branch Block (RBBB)There is STE in I and aVL, V5, V6, with reciprocal STD in II, III, aVFThere is appropriately discordant ST depression in V1-V3 (appropriate...
A 57-year-old man with atherosclerosis obliterans was admitted with sudden-onset sensory aphasia and right hemiparesis. Brain MRI revealed acute cerebral infarctions in the left temporal lobe and magnetic resonance angiography showed occlusion of the posterior branch of the left middle cerebral artery. Transesophageal echocardiography and ultrasonography respectively confirmed a patent foramen ovale and deep vein thrombosis in the bilateral femoral veins. Blood findings showed low protein S antigen, low protein S activity, and a missense mutation of the PROS 1 gene.
CONCLUSION: Despite widespread use of rTMS, high-quality evidence for its routine use for the treatment of stroke survivors is lacking. Further studies are required to establish differential roles of various protocols and long-term effects of rTMS in the stroke population. PMID: 31922207 [PubMed - as supplied by publisher]