Speech and language outcome after unilateral basal ganglia infarctions acquired during childhood: A combined neuropsychological and neuroimaging study

The aims of these studies were to determine the long-term consequences of unilateral basal ganglia damage on speech and language after childhood stroke, and to relate functional deficits to structural and functional changes in the brain. Patients with either left or right hemisphere infarction of the basal ganglia and no obvious cortical involvement on conventional neuroradiological examination took part in these studies. Neuropsychological assessments were used to evaluate the incidence and types of speech and language deficits. These investigations revealed impairments in articulation, with particular difficulties in the execution of sequential articulatory procedures, and some evidence for deficits in the acquisition of novel articulatory plans. Most of these difficulties occurred regardless of side of injury. Evidence for some impairment on receptive and expressive language functions, reading and spelling was also apparent, again regardless of side of injury. The absence of predicted differences related to side of injury on language performance was attributed, at least in part, to the considerably greater variance in the performance of the patients with left hemisphere injuries. Resulting neuropsychologcal profiles were related to the precise site and extent of lesions, using a range of magnetic resonance imaging (MRI) techniques, including conventional clinical imaging, voxel based morphometric (VBM) analyses of 3D data sets and diffusion tensor images, and perfusion imaging. VBM analyses of MR scans highlighted regions of grey and white matter density beyond the core site of the infarction, including Broca's and Wernicke's areas, that correlated with language performance in patients with left hemisphere injuries and not in those with right hemisphere injuries or control subjects. Furthermore, the three patients with poorest language function had haemodynamic abnormalities involving left hemisphere cortical language areas that were not observed in the other patients. All patients were seen in long-term follow up, and so recovery and/or reorganisation might have taken place, thus complicating the structure-function relationships. Performance on previous neuropsychological assessments was therefore compared to performance on neuropsychological assessments carried out for these studies. Dichotic listening, functional magnetic resonance imaging (fMRI) and event related potential (ERP) techniques were also used to examine the status of language organisation. Results suggested that the variation in performance seen in the language studies could not be attributed to changes in performance over the course of recovery or reorganisation of function. It was therefore concluded that language deficits after basal ganglia infarctions acquired during childhood might have been related to additional changes in grey and white matter, as well as haemodynamic abnormalities, affecting cortical language regions

Caudate Infarcts

Eighteen Patients Had Caudate Nucleus Infarcts (10 Left-Sided; 8 Right-Sided). Infarcts Extended into the Anterior Limb of the Internal Capsule in 9 Patients, and Also the Anterior Putamen in 5 Patients. Thirteen Patients Had Motor Signs, Most Often a Slight Transient Hemiparesis. Dysarthria Was Common (11 Patients). Cognitive and Behavioral Abnormalities Were Frequent, and Included Abulia (10 Patients), Agitation and Hyperactivity (7 Patients), Contralateral Neglect (3 Patients, All Right Caudate), and Language Abnormalities (2 Patients, Both Left Caudate). the Majority of Patients Had Risk Factors for Penetrating Artery Disease. Branch Occlusion of Heubner\u27s Artery, or Perforators from the Proximal Anterior or Middle Cerebral Arteries Were the Posited Mechanism of Infarction. © 1990, American Medical Association. All Rights Reserved

Infratentorial Abnormalities in Vascular Dementia

Background and Purpose—Infratentorial abnormalities may cause cognitive deficits, but current research criteria for vascular dementia (VaD) do not consider them. Our purposes were to determine the prevalence of infratentorial abnormalities in VaD, their relation with supratentorial abnormalities, and whether they are relevant to cognition. Methods—We examined 182 patients (120 men, mean age 73 years, SD 8) with probable VaD at inclusion into a multicenter clinical trial. MRI scans were evaluated for infratentorial vascular abnormalities, midbrain atrophy, cerebellar atrophy, basilar artery diameter and tortuosity, and supratentorial abnormalities. Cognitive testing included the mini–mental state examination (MMSE) and the vascular dementia assessment scale (VaDAS-cog). Results—One hundred forty-one (77.5%) patients had infratentorial abnormalities: 119 (65.4%) had focal infratentorial vascular lesions, 65 (35.7%) had diffuse pontine vascular abnormalities hyperintense on T2-weighted images, 20 (11.0%) had midbrain atrophy, and 16 (8.8%) had cerebellar atrophy. Significant correlations were found between number of infratentorial vascular lesions and basilar artery diameter (rs 0.26; P 0.0001), infratentorial and basal ganglia (including thalamus) vascular abnormalities (rs 0.30; P 0.0001), as well as between midbrain atrophy and global supratentorial atrophy (rs 0.27; P 0.0001). Infratentorial vascular abnormalities and cerebellar atrophy were not significantly associated with cognitive impairment. Patients with midbrain atrophy performed worse on cognitive tests than those without midbrain atrophy. After correction for sex, age, education, supratentorial abnormalities, and center, midbrain atrophy remained significantly associated with lower MMSE scores (P 0.05). Conclusions—Infratentorial abnormalities often occur in patients with VaD, but only midbrain atrophy was found to be relevant to cognitio

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

Motor symptoms in Parkinson's disease: A unified framework

Parkinson’s disease (PD) is characterized by a range of motor symptoms. Besides the cardinal symptoms (akinesia and bradykinesia, tremor and rigidity), PD patients show additional motor deficits, including: gait disturbance, impaired handwriting, grip force and speech deficits, among others. Some of these motor symptoms (e.g., deficits of gait, speech, and handwriting) have similar clinical profiles, neural substrates, and respond similarly to dopaminergic medication and deep brain stimulation (DBS). Here, we provide an extensive review of the clinical characteristics and neural substrates of each of these motor symptoms, to highlight precisely how PD and its medical and surgical treatments impact motor symptoms. In conclusion, we offer a unified framework for understanding the range of motor symptoms in PD. We argue that various motor symptoms in PD reflect dysfunction of neural structures responsible for action selection, motor sequencing, and coordination and execution of movement

The aetiology, investigation and outcome of ischaemic stroke in childhood

The aetiology, investigation and outcome of ischaemic stroke were studied in a population of 128 children. Cerebrovascular abnormalities were present in the majority of children; in many cases these conformed to specific diagnostic categories, with implications for management. In contrast, previously unrecognised non-vascular risk factors for stroke were relatively rare. In particular, the prevalence of inherited prothrombotic states was no higher in children with stroke than in control populations. Although magnetic resonance angiography was useful in identifying cerebrovascular lesions, conventional cerebral angiography had a continuing and definable role in the investigation of the child with ischaemic stroke. In the investigation of outcome after ischaemic stroke a simple questionnaire investigating parents' perception of residual disability was shown to correlate well with therapists' and neuropsychological assessment. Over half the children in this population had significant residual deficits; the incidence of recurrent stroke was 17% over 5 years. A younger age at the time of stroke was associated with worse outcome. However, prognosis was not influenced by other clinical factors. In a subgroup of 38 children with lesions in the territory of a middle cerebral artery, although the location of the lesion was not related to outcome, outcome was poor in all patients who had infarcted at least 10% of intracranial volume had. Lesion size could, therefore, be used to identify patients at high risk of long term disability for future treatment trials. These findings support the view that there is a role for both acute treatment and secondary prevention in children with ischaemic stroke. This study has characterised in detail a large population of children with ischaemic stroke and has given rise to several practical recommendations about the investigation and management of such patients

Isolated, subtle, neurological abnormalities in neurologically and cognitively healthy aging subjects

The aim of this study is to describe the frequency of isolated, subtle, neurological abnormalities (ISNAs) in a large population of neurologically and cognitively healthy subjects and to compare ISNAs to various types of MRI-detected cerebrovascular lesions and subcortical brain atrophy in different age classes. 907 subjects were selected from a large, prospective hospital-based study. At baseline neurological examination, 17 ISNAs were selected. Primitive reflexes were the most common ISNAs (35.8 %), while dysphagia was the most rarely encountered (0.3 %). Measures of small vessel disease, i.e., deep and subcortical white matter hyperintensity and lacunar infarcts as well as subcortical atrophy, were variously associated with ISNAs. In the adult group, the ISNAs were associated with hypertriglyceridemia, TIA, and subcortical lacunar infarcts, while in the elderly-old group they were associated with arterial hypertension, subcortical white matter hyperintensity, and subcortical atrophy. An increased risk of ISNAs was associated with lacunae and white matter hyperintensity in the parietal region. This study shows that white matter hyperintensity, lacunae, and subcortical atrophy are associated with an increased risk of ISNAs in cognitively and neurologically healthy aging subjects. ISNAs are not benign signs. Therefore, adults and elderly people presenting with ISNAs should have access to accurate history and diagnosis to prevent progression of small vessel disease and future neurological and cognitive disabilities

Diabetic striatopathy: an updated overview of current knowledge and future perspectives

Purpose: Diabetic striatopathy (DS) is a rare complication of poorly controlled diabetes mellitus (DM), characterized by hyperglycemia associated with chorea/ballism and characteristic reversible basal ganglia abnormalities on computed tomography (CT) and/or magnetic resonance imaging (MRI). We propose a narrative review of the literature on this topic, currently unknown to most, and about which physicians should be aware. We intend to summarize, critically review, and take to mean the evidence on this disorder, describing its typical features. Methods: We searched Pubmed for English-language sources using the following keywords in the title and the abstract: diabetic striatopathy, hyperglycemic non-ketotic hemichorea/hemiballism, chorea/hemichorea associated with non-ketotic hyperglycemia, diabetic hemiballism/hemichorea, chorea, hyperglycemia, and basal ganglia syndrome. We collected scientific articles, including case reports, reviews, systematic reviews, and meta-analyses from the years 1975 to 2023. We eliminated duplicate, non-English language or non-related articles. Results: Older Asian women are more frequently affected. Suddenly or insidiously hemichorea/hemiballism, mainly in the limbs, and high blood glucose with elevated HbA1c in the absence of ketone bodies have been observed. Furthermore, CT striatal hyperdensity and T1-weighted MRI hyperintensity have been observed. DS is often a treatable disease following proper hydration and insulin administration. Histopathological findings are variable, and no comprehensive hypothesis explains the atypical cases reported. Conclusion: DS is a rare neurological manifestation of DM. If adequately treated, although treatment guidelines are lacking, the prognosis is good and life-threatening complications may occur occasionally. During chorea/hemiballism, we recommend blood glucose and HbA1c evaluation. Further studies are needed to understand the pathogenesis