Apraxia of speech and cerebellar mutism syndrome: a case study

Background Cerebellar mutism syndrome (CMS) or posterior fossa syndrome (PFS) consists of a constellation of neuropsychiatric, neuropsychological and neurogenic speech and language deficits. It is most commonly observed in children after posterior fossa tumor surgery. The most prominent feature of CMS is mutism, which generally starts after a few days after the operation, has a limited duration and is typically followed by motor speech deficits. However, the core speech disorder subserving CMS is still unclear. Case presentation This study investigates the speech and language symptoms following posterior fossa medulloblastoma surgery in a 12-year-old right-handed boy. An extensive battery of formal speech (DIAS = Diagnostic Instrument Apraxia of Speech) and language tests were administered during a follow-up of 6 weeks after surgery. Although the neurological and neuropsychological (affective, cognitive) symptoms of this patient are consistent with Schmahmann’s syndrome, the speech and language symptoms were markedly different from what is typically described in the literature. In-depth analyses of speech production revealed features consistent with a diagnosis of apraxia of speech (AoS) while ataxic dysarthria was completely absent. In addition, language assessments showed genuine aphasic deficits as reflected by distorted language production and perception, wordfinding difficulties, grammatical disturbances and verbal fluency deficits. Conclusion To the best of our knowledge this case might be the first example that clearly demonstrates that a higher level motor planning disorder (apraxia) may be the origin of disrupted speech in CMS. In addition, identification of non-motor linguistic disturbances during follow-up add to the view that the cerebellum not only plays a crucial role in the planning and execution of speech but also in linguistic processing. Whether the cerebellum has a direct or indirect role in motor speech planning needs to be further investigated

Population bottleneck has only marginal effect on fitness evolution and its repeatability in dioecious Caenorhabditis elegans

The predictability of evolution is expected to depend on the relative contribution of deterministic and stochastic processes. This ratio is modulated by effective population size. Smaller effective populations harbor less genetic diversity and stochastic processes are generally expected to play a larger role, leading to less repeatable evolutionary trajectories. Empirical insight into the relationship between effective population size and repeatability is limited and focused mostly on asexual organisms. Here, we tested whether fitness evolution was less repeatable after a population bottleneck in obligately outcrossing populations of Caenorhabditis elegans. Replicated populations founded by 500, 50, or five individuals (no/moderate/strong bottleneck) were exposed to a novel environment with a different bacterial prey. As a proxy for fitness, population size was measured after one week of growth before and after 15 weeks of evolution. Surprisingly, we found no significant differences among treatments in their fitness evolution. Even though the strong bottleneck reduced the relative contribution of selection to fitness variation, this did not translate to a significant reduction in the repeatability of fitness evolution. Thus, although a bottleneck reduced the contribution of deterministic processes, we conclude that the predictability of evolution may not universally depend on effective population size, especially in sexual organisms

Neurogenic foreign accent syndrome: Articulatory setting, segments and prosody in a Dutch speaker

Foreign accent syndrome (FAS) can be defined as a motor speech disorder in which patients develop a speech accent which is notably different from their premorbid habitual accent. This paper aims to provide an explicit description of the neurolinguistic and phonetic characteristics of a female speaker of Belgian Dutch who suffered from neurogenic FAS in which she developed a French/German foreign accent after a left hemisphere stroke. A detailed phonetic analysis of the speaker’s pronunciation errors revealed problems at both the segmental and suprasegmental level. At the segmental level a wide variety of pronunciation errors were observed which are consistent with a tense articulatory setting: creaky voice, strengthening of fricatives into stops and more carefully articulated consonants and vowels. The data suggest that the perception of the French accent may have resulted from a combination of speech pathology features and unaffected regional pronunciation characteristics of the patient’s Standard Dutch. In contrast to the traditional view in the literature that FAS represents a primary dysprosodic disturbance, a detailed analysis of the speaker’s intonation contours by means of the stylization method revealed the entirely correct implementation of the most common pitch contours of Standard Dutch. This unique finding shows that FAS does not by definition follow from disruption of prosodic processing. However, the frequency of occurrence of the different types of pitch contours was clearly deviant since the patient very frequently used the Dutch continuation rise. It is hypothesized that this might represent a deliberate strategy of the speaker to stay in control of the speaking situation by keeping the speaking turn which she is at continuous risk of losing as the result of long and frequent pausing

Developmental Foreign Accent Syndrome: report of a new case

This paper presents the case of a 17-year-old right-handed Belgian boy with developmental FAS and comorbid developmental apraxia of speech (DAS). Extensive neuropsychological and neurolinguistic investigations demonstrated a normal IQ but impaired planning (visuo-constructional dyspraxia). A Tc-99m-ECD SPECT revealed a significant hypoperfusion in the prefrontal and medial frontal regions, as well as in the lateral temporal regions. Hypoperfusion in the right cerebellum almost reached significance. It is hypothesized that these clinical findings support the view that FAS and DAS are related phenomena following impairment of the cerebro-cerebellar network

Koliek bij het paard: een retrospectieve studie : prevalentie, resultaten van conservatieve en operatieve behandeling

A retrospective study was performed on 2,264 horses pesented with colicn at Ghent University (Belgium) in the period 1986-1994. In this article, parameters not directly related to a specific type of colic are discussed. Approximately 32% of all horses addmitted to the clinic of Internal Diseases were presented because of colic. The colic pathology was observed mainly during the spring. A significantly great number of mares and warmblood riding horses was observed mainly during the spring. A significantly great number of mares and warmblood riding horses were presented, and significantly lower number of stallions and halfblood horses. The prevalence of colic increased with age, stagnating around age 13. One thousand one hundred sixty-eight exploratory laparotomies were performed on 1,069 horses. During the period 1986-1994 the number of surgical interventions gradually increased. The short-term survival rate also increased progressively: by the end of the period studied, it had reached 87% for conservative treatment and 73% for surgical corrections. A variable successn rate after surgery was observed among the different surgeons. The determining factors for this variable success were the surgeon's individual experience in abdominal surgery and the period in which the exploratory laparotomies were performed. the success rate after non-invasive or minimally invasive surgical techniques was significantly better than after the use of invasive techniques. The most commonly observed postoperative complications were thrombophlebitis, diarrhea, wound infection and laminitis

Een retrospectieve studie van chirurgisch behandelde specifieke koliekaandoeningen bij het paard

In the period 1986-1994 a retrospective study was performed on 2,264 horses with colic at the Faculty of Veterinary Medicine of the Ghent University/Belgium. An exploratory laparotomy was performed in 1,069 horses. In this study the observed pathological conditions in the different parts of the gastrointestinal tract are thoroughly discussed in depth. The origin of colic symptoms was determined by rectal examination or exploratory laparotomy: it was localized in the ascending colon in 31% of the horses and in the small intestine in 25% of them. Less frequently observed localizations were the caecum (8%), the descending colon (3%), the stomach (3%) and the rectum (1%). The localization of colic pathology could not or not exactly be determined in 28% of the cases. Short time survival rates were used. The overall survival rate of conservative and surgical treatment of horses with pathology of the descending colon and pathology of the caecum and/or ascending colon was respectively 80% and 75%. The survival rate of horses with pathology of the small intestine, the rectum and the stomach was less favorable: 54%, 35% and 32% respectively. The risk of developing colic was statistically analyzed according to breed, gender and age. Foals less than I year old ran a significantly higher risk of small intestinal volvulus. Geldings and Warmblood horses had a higher incidence of incarceration through the foramen omentale (epiploicon), whereas females and foals had a lower incidence. An inguinal hernia was significantly more often observed in foals and stallions, and significantly less in mares and geldings. Horses aged 9-12 years showed a higher risk of caecal tympany, whereas ponies, males, foals and horses aged 1-4 years ran an increased risk of (ileo)caecal intussusception. Mares and horses aged 1-4 or 5-8 years had a higher incidence of pelvic flexure impaction. The incidence of right colonic displacement was lower in males and foals. Older horses and mares were at significantly greater risk of developing a colon torsion. A higher incidence of left dorsal displacement was observed in geldings and a lower incidence in females

Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium : a BelSACI-Abeforcal-EUFOREA statement

Allergic rhinitis (AR) affects 23-30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient-and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium