Zaburzenia językowe oraz mowy w praktyce ogólnolekarskiej

Artykuł omawia zaburzenia komunikacji językowej oraz problemy artykulacyjne spotykane w praktyce ogólnolekarskiej. Scharakteryzowano: (a) objawy i podłoże neuroanatomiczne poszczególnych zespołów afazji w ujęciu klasycznym i współczesnym, (b) problemy językowe po uszkodzeniu półkuli podległej mózgu (prawej), (c) zaburzenia językowe w wybranych zespołach otępiennych, oraz (d) niektóre rodzaje dyzartrii. Forum Medycyny Rodzinnej 2008, tom 2, nr 1, 14-2

Aging and Hypertension – Independent or Intertwined White Matter Impairing Factors? Insights From the Quantitative Diffusion Tensor Imaging

Aging disrupts white matter integrity, and so does continuous elevated blood pressure that accompanies hypertension (HTN). Yet, our understanding of the interrelationship between these factors is still limited. The study aimed at evaluating patterns of changes in diffusion parameters (as assessed by quantitative diffusion fiber tracking – qDTI) following both aging, and hypertension, as well as the nature of their linkage. 146 participants took part in the study: the control group (N = 61) and the patients with hypertension (N = 85), and were divided into three age subgroups (25–47, 48–56, 57–71 years). qDTI was used to calculate the values of fractional anisotropy, mean, radial and axial diffusivity in 20 main tracts of the brain. The effects of factors (aging and hypertension) on diffusion parameters of tracts were tested with a two-way ANOVA. In the right hemisphere there was no clear effect of the HTN, nor an interaction between the factors, though some age-related effects were observed. Contrary, in the left hemisphere both aging and hypertension contributed to the white matter decline, following a functional pattern. In the projection pathways and the fornix, HTN and aging played part independent of each other, whereas in association fibers and the corpus callosum if the hypertension effect was significant, an interaction was observed. HTN patients manifested faster decline of diffusion parameters but also reached a plateau earlier, with highest between-group differences noted in the middle-aged subgroup. Healthy and hypertensive participants have different brain aging patterns. The HTN is associated with acceleration of white matter integrity decline, observed mainly in association fibers of the left hemisphere

Early recanalisation of middle cerebral artery in thrombolytic therapy of cardiogenic stroke - a case study

Udary niedokrwienne stanowią 85–90% udarów mózgu, większość z nich to rezultat niedrożności tętnic mózgowych lub szyjnych. Wysoka śmiertelność oraz znaczny odsetek chorych obarczonych trwałym inwalidztwem wskazują na konieczność poszukiwania skuteczniejszych form terapii. Tromboliza mózgowa pozwala na istotne zmniejszenie deficytu neurologicznego. W pracy przedstawiono przypadek 54-letniego mężczyzny, u którego zastosowano leczenie trombolityczne w przebiegu kardiogennego ogniska niedokrwiennego mózgu w dorzeczu tętnicy mózgu środkowej. Poprawa stanu neurologicznego (regresja objawów ogniskowych) nastąpiła już w pierwszej godzinie leczenia i.v. rekombinowanym tkankowym aktywatorem plazminogenu (rt-PA). Rekanalizację tętnicy mózgu środkowej potwierdzono badaniem przezczaszkowej ultrasonografii dopplerowskiej.Acute ischaemic stroke constitutes 85–90% of all stroke subtypes. Majority of brain ischaemia results from cerebral or carotid arteries occlusion. High mortality and invalidity due to stroke are still unsatisfactory. Thrombolytic therapy enables recovery improvement and significant reduction of neurological deficits. In this report we present a case of 54-year-old male with ischaemic stroke of cardiogenic origin in territory of middle cerebral artery. Significant neurological recovery was observed during the first hour of i.v. rt-PA infusion. Recanalisation of middle cerebral artrery was confirmed with Transcranial Doppler examination

Neuropsychologia jesieni życia

Contemporary debate on human aging is intensive and multifaceted in nature because of agerelated transformation in many contemporary societies, i.e. a rapid increase of mean life expectancy (increasing numbers of healthy old people). The aim of this article is to discuss changes in brain and behavior that occur in later life. Life-span developmental neuropsychology emphasizes a close relationship between cognitive problems in later life and age-related loss of large neurons in some parts of the brain. Large neurons shrink into smaller neuron classes. The most pronounced atrophic changes have been reported in the prefrontal area, hippocampus, ubstantianigra and locus cinereus. This article presents also common clinical conditions of later life, such as differential diagnosis of age-associated behavioral changes and dementias. There may be multiple causes of neurogeriatric disorders, such as Alzheimer’s disease. There has been considerable interest in the possible causative role of cognitive and brain reserve which differs among individuals. Therefore between-individual heterogeneity related to normal cognitive aging is signifi cant. Namely, if cerebral pathology occurs (e.g., neurodegeneration with dementia), persons with a greater reserve may not demonstrate the same cognitive impact as others with the same pathology (e.g. lesion size) but less reserve. It is also widely believed that mental difficulties in lder adults cannot be easily attributed to psychomotor slowness which may reflect a loss of white matter tissue, i.e. dysmielinisation of nerve fibers. This article emphasizes an importance of ecologically valid assessment of older adults, whose everyday activities and real--world abilities cannot be predicted by the traditional tests and sophisticated procedures emerging from purely experimental investigations

Review article Prevalence and clinical specificity of fatigue symptoms in chronic fatigue syndrome, multiple sclerosis, and myasthenia gravis

This article provides a critical review of the psychological and related literature on fatigue resulting in both mental and physical experiences. On one hand, prolonged severe fatigue is a prominent disabling symptom in various diseases of different aetiology – psychiatric (e.g. depression), somatic (e.g. some infections) and neurologic (e.g. multiple sclerosis, myasthenia gravis). For instance, fatigue is a main symptom of myasthenia that leads to pathological skeletal muscle weakness. Furthermore, 40 to 90 per cent of individuals suffering from multiple sclerosis confirm they have experienced fatigue, which impairs their cognitive functioning. In both multiple sclerosis and myasthenia, fatigue has not only a physical but also a psychological dimension. On the other hand, fatigue can be seen as an isolated set of symptoms of unknown origin called the chronic fatigue syndrome (CFS). The development of the concept, diagnostic criteria and some strategies of coping with CFS are presented. Various somatic disorders, as well as subjective cognitive and emotional complaints, are common and well documented in patients with CFS. The most typical include depression, as well as problems with concentration of attention, decision-making and reasoning in complex situations. However, general intellectual abilities and higher order cognitive skills are intact. Directions for future research are outlined

Functional and neuroanatomical analysis of extralinguistic disorders in right hemisphere-damaged patients

The purpose of this article was to determine the prevalence of extralinguistic (non-aphasic)disorders, its clinical picture, and neuroanatomical correlates in right hemisphere – damaged patients. The cerebral perfusion pattern was determined by single-photon emission computed tomography (SPECT) in a group of 40 stroke patients with damage to the right hemisphere (RHD). The ontrol group included 60 healthy subjects. The Polish version of the Right Hemisphere Language Battery (RHLB-PL) was used in the study. The group of RHD patients was not homogeneous with respect to character and severity of language disturbances. Some patients show very mild and selective linguistic disturbances, while others demonstrate more serious and generalized difficulties. The RHD patients, in comparison to healthy individuals, exhibited several communicative impairments, “apragmatic” in nature,including difficulties in performing tests assessing inferential reasoning, lexical-semantic processes, metaphor comprehension, and receptive prosody. Discourse ability seems to be particularly susceptible to damage since 95% of patients obtained abnormal scores for Discourse Analysis. Language disorders assessed by the RHLB-PL were associated with a variety of SPECT findings: language difficulties coexisted with perfusion defects within RH mostly involving the frontal cortex and thalamus

Specificity and time-course of post-stroke executive dysfunctions in light of the longitudinal study

Cerebral stroke is the very common cause of executive dysfunctions, such as disinhibition and inability to switch of attention. The aim of this longitudinal study was to determine a clinical characteristic of executive dysfunctions in light of the neuropsychological examinations. Forty-four patients who had ischemic stroke were examined twice with a twelve-month interval. At each session executive functions were measured on the same patients. Executive functioning was measured by three popular tasks, i.e. an experimental version of the Stroop Color- Word Interference Test, Verbal Fluency Test, and Trail Making Test. Twenty-five healthy volunteers were examined once only to transform patients’ results of neuropsychological testing into standardized form. Executive impairment was found in 24 patients (i.e. 65% of the clinical group), who failed to complete at least one of the three tests. Patients manifested executive dysfunctions which were highly heterogeneous with respect to character, severity and their prevalence. Overall, there was clear evidence that executive functions showed substantial recovery. Timecourse of distinct executive dysfunctions was similar