1/66. cocaine-associated stroke: three cases and rehabilitation considerations.cocaine-associated stroke (CAS) is an important cause of disability, especially among younger adults. Improved management has increased survival but little has been discussed about rehabilitation, including medication management. Therefore, experience and therapeutic drug management are described during inpatient rehabilitation with three patients with CAS. Case 14 is a 50-year-old male with a history of hypertension who presented with right hemiparesis, aphasia and depression. He was treated with paroxetine for depression and bromocriptine for poor initiation with a good response, improving by 50 FIM points in 44 days. Case 2 is a 44 year-old female with quadriparesis, aphasia, and deficits in attention and initiation. methylphenidate for attention deficits and bromocriptine for poor initiation was associated with an excellent functional gain (50 FIM points in 37 days). She eventually returned to work. Case 3 is a 46-year-old female with a history of hypertension who presented with right hemiparesis, aphasia and depression. Without neuropharmacologic intervention, she gained 35 FIM points during an uneventful 47 day rehabilitation stay. Acutely, cocaine can induce cerebral vasoconstriction, cerebrovascular spasm, cerebral vasculitis and intracerebral haemorrhage. Chronic use depletes and destroys dopaminergic pathways, which may be a major factor in depression, and attention and initiation deficits-all observed in these cases. Generally, rapid improvements were seen in mood and cognition in two cases where medication was used. Based on the current literature and pathophysiology of CAS, it is suggested that trials of dopaminergic agents for cognition and extremely cautious use of buproprion for depression may be warrented. Details of the above cases and the practical and theoretical issues of neuropharmacologic intervention in CAS are discussed.- - - - - - - - - - ranking = 1keywords = disability (Clic here for more details about this article) |
2/66. perfusion brain scintigraphy studies in infants and children with malformations of the vein of Galen.Cerebral perfusion brain scintigraphy obtained in six unselected patients (age newborn to 14 years) from among 50 children with vein of galen malformations was used in conjunction with magnetic resonance imaging to determine the basis of the neurological and cognitive abnormalities in patients with vein of galen malformations (VGMs). Five had a hemiparesis - persistent, transient, or alternating. Four were developmentally delayed. Two had so far been cognitively normal and acquired a neurological deficit, following an embolization procedure. The school age patient had a nonverbal learning disability. Three had epilepsy and/or an abnormal electroencephalogram. magnetic resonance imaging documented only the VGM, hydrocephalus and atrophy; one child with perinatal asphyxia had periventricular leukomalacia. perfusion brain scintigraphy was normal in two (a normal infant, and a toddler with a hemiparesis and aphasia). Abnormal findings included: left parietal hypoperfusion, fronto-temporal atrophy, patchy flow; left fronto-temporal hypoperfusion, left hemiatrophy, bilateral medial temporal hypoperfusion, right cerebellar hypoperfusion; right temporal hypoperfusion, patchy flow; right hemiatrophy, occipital hypoperfusion. perfusion brain scintigraphy findings correlated better with focal neurological and cognitive defects than did magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = disability (Clic here for more details about this article) |
3/66. Profound postoperative hypoglycemia in a malnourished patient.PURPOSE: To present an unusual case of profound postoperative hypoglycemia resulting in irreversible brain damage in a malnourished patient. CLINICAL FEATURES: A 56-yr-old malnourished woman underwent laparotomy for intestinal obstruction under general anesthesia. Five hours postoperatively she was found to be unresponsive with an immeasureably low blood glucose level. This event was not associated with hyperinsulinemia. Predisposing factors like diabetes mellitus, pheochromocytoma, insulin secreting tumours, adrenal or pitutary deficiency were absent. She was treated with iv dextrose and hydrocortisone with blood glucose levels stabilizing fairly rapidly. However, she unfortunately had sustained irreversible cerebral damage and is left with significant neurological disability. CONCLUSION: Severe postoperative hypoglycemia has several well documented causes. Although hypoglycemia does occur to a moderate degree in malnutrition, it has not been reported to be so severe as to cause cerebral damage in the postoperative setting.- - - - - - - - - - ranking = 1keywords = disability (Clic here for more details about this article) |
4/66. names and words without meaning: incidental postmorbid semantic learning in a person with extensive bilateral medial temporal damage.The authors describe a densely amnesic man who has acquired explicit semantic knowledge of famous names and vocabulary words that entered popular culture after the onset of his amnesia. This new semantic knowledge was temporally graded and existed over and above the implicit memory he demonstrated in reading speed and accuracy, familiarity ratings, and his ability to make correct guesses on unfamiliar items. However, his postmorbid knowledge was limited to verbal labels denoting famous people and words; he possessed virtually no explicit knowledge of the meaning of these words or the identities of these individuals, although there was some evidence that some of this information had been acquired at an implicit level. Findings are discussed in the context of a neural network model (J. L. McClelland, B. L. McNaughton, & R. C. O'Reilly, 1995) of semantic acquisition.- - - - - - - - - - ranking = 446.65149013729keywords = reading (Clic here for more details about this article) |
5/66. Discrepant oral and written spelling after left hemisphere tumour.Repetition, reading, confrontation naming, and oral and written spelling were studied in a 57 year-old man with a left hemisphere tumour. These tasks were repeated over a period of two weeks when the patient was being treated for brain oedema prior and subsequent to neurosurgical intervention. In the context of intact repetition and good reading, the most striking finding was a significant qualitative and quantitative discrepancy between oral and written spelling, with the latter task more severely affected. The pattern on oral spelling was that of lexical (or surface) agraphia. On written output, however, orthographic errors predominated. The relatively greater impairment of written spelling was not secondary to a motoric or visuo-spatial deficit. The observed patterns are not easily accommodated by current models of writing.- - - - - - - - - - ranking = 893.30298027457keywords = reading (Clic here for more details about this article) |
6/66. Deterioration of word meaning: implications for reading.We investigated six patients with progressive focal dementia or progressive aphasia, who showed impairments in knowledge of word meaning ranging from moderate to very severe. In all cases, a test of oral word reading demonstrated preserved reading of words with regular spelling-to-sound correspondences (e.g. MINT), but impaired reading of words with atypical correspondences (e.g. PINT). The level of success on these "exception" words was significantly related to word frequency, and the most common error was the assignment of a more typical spelling-sound correspondence. Various explanations are considered for this common association between loss of word meaning and a surface alexic pattern of reading performance.- - - - - - - - - - ranking = 3573.2119210983keywords = reading (Clic here for more details about this article) |
7/66. Selective impairment for reading numbers and number words: a single case study.The article reports the case of a patient who showed a selective inability in reading multi-digit numbers following recovery from aphasic disorders. Although his ability to read words, non-words, syntagms and sentences was almost preserved, he made errors with Arabic numerals and number words. Different types of errors with alphabetic material were also observed: he made only rare phonological substitutions with linguistic stimuli, whereas errors were almost always lexical in reading number words. A series of experiments showed that his ability to access number semantics was intact. In contrast, he selectively failed in all production tasks (including calculation), but only when the required response was in the oral output modality. This pattern was interpreted in terms of a selective deficit to the spoken number name production system. Furthermore, the different types of errors made with alphabetic materials belonging to the two classes of stimuli (numerical versus non-numerical) further support the hypothesis of a categorical organisation in the lexical-semantic system.- - - - - - - - - - ranking = 2679.9089408237keywords = reading (Clic here for more details about this article) |
8/66. Extreme risk taker who wants to continue taking part in high risk sports after serious injury.The case is reported of a 40 year old male high risk sport athlete who had seriously injured himself several times and as a result was partially physically disabled and had trouble with mental tasks requiring concentration such as spelling, reading numbers, and writing. The athlete was referred to a sports psychologist. In consultations, it became clear that he was having difficulty reconciling the difference between his life as it used to be and as it would be in the future. Part of his difficulty was dealing with the frustration and anger "outbursts" which resulted from not being able to perform straightforward everyday motor skills. In spite of his injuries and disability, the patient badly wanted to continue participating in extreme sports. Reversal theory is used in the discussion to provide theoretical explanations of the motivation for his extreme risk taking behaviour.- - - - - - - - - - ranking = 447.65149013729keywords = reading, disability (Clic here for more details about this article) |
9/66. Right hemisphere reading mechanisms in a global alexic patient.We investigated the implicit, or covert, reading ability of a global alexic patient (EA) to help determine the contribution of the right hemisphere to reading. Previous studies of alexic patients with left hemisphere damage have suggested that the ability to derive meaning from printed words that cannot be read out loud may reflect right hemisphere reading mechanisms. Other investigators have argued that residual left hemisphere abilities are sufficient to account for implicit reading and moreover do not require the postulation of a right hemisphere system that has no role in normal reading processes. However, few studies have assessed covert reading in patients with lesions as extensive as the one in EA, which affected left medial, inferior temporal-occipital cortex, hippocampus, splenium, and dorsal white matter. EA was presented with lexical decision, semantic categorization, phonemic categorization, and letter matching tasks. Although EA was unable to access phonology and could not overtly name words or letters, she was nevertheless capable of making lexical and semantic decisions at above chance levels, with an advantage for concrete versus abstract words. Her oral and written spelling were relatively intact, suggesting that orthographic knowledge is retained, although inaccessible through the visual modality. Based on her ability to access lexical and semantic information without contacting phonological representations, we propose that EA's implicit reading emerges from, and is supported, by the right hemisphere. Finally, we conclude that her spelling and writing abilities are supported by left hemisphere mechanisms.- - - - - - - - - - ranking = 4913.1663915102keywords = reading (Clic here for more details about this article) |
10/66. Perseveration or the Tower of Babel.The purpose of this article is twofold: (1) to present a study of perseveration in a continuous series of 50 left brain-damaged aphasic subjects and (2) to describe the treatment of 2 patients with high rates of perseveration. In the group of 50 subjects, 20 showed two or more perseverations in one or more language tasks. No difference in number of perseverations was found between fluent and nonfluent subjects, but perseverations in global aphasic subjects with stereotyped speech were less varied than they were in fluent aphasic subjects and were not unlike other types of recurrent utterances. Of the two patients who received treatment, subject 1 had severe semantic disruption and perseverated in all production and comprehension tasks, except in repetition, reading aloud, and writing to dictation, all of which could be performed by the undamaged sublexical routines. Treated subject 2 had writing disorders that were ascribed to damage to the output buffer. She perseverated in all writing tasks. rehabilitation of the semantic system in subject 1 and of the output buffer in subject 2 greatly reduced the number of perseverations in both subjects. It is argued that recovery of the underlying functional damage reduces the perseverative behavior.- - - - - - - - - - ranking = 446.65149013729keywords = reading (Clic here for more details about this article) |
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