Crossed aphasia in a dextral: a test of the Alexander-Annett theory of anomalous organization of brain function.

A case of crossed aphasia is presented in a strongly right-handed 77-year-old white female without history of familial sinistrality or prior neurological illness. She developed a right middle cerebral artery infarction documented by CT and accompanied by obvious clinical signs of a conduction aphasia with some resolution but continuing obvious language defect after 9 weeks in rehabilitation. Comprehensive neuropsychological and aphasia testing suggested anomalous lateralization of phonologic-output aspects of language, emotional prosody, motor planning and body schema modules with usual lateralization of lexical-semantic aspects of language and visuo-spatial functions. Experimental validation of the uncrossed lexical-semantic aspects of language using tachistoscope methods found support for the Alexander-Annett theory that different aspects of language can be dissociated in their lateralization. The subject had difficulty identifying a semantic associate of a picture presented to the left visual field (7 errors out of 10) relative to right visual field presentation (2 errors out of 10). Bilateral free naming errors (6 and 5 errors in the left and right visual fields, respectively) occurred consistent with the aphasic presentation, suggesting phonologic-output dysfunction from the right cerebral vascular accident. Implications of the results for aphasia classification are discussed.

Neurobehavioral Cognitive Status Examination: its use with unilateral stroke patients in a rehabilitation setting.

The Neurobehavioral Cognitive Status Examination (NCSE) was administered to 12 patients with right unilateral stroke and 12 with left unilateral stroke and to 12 orthopedic, non-brain-dysfunctional patients who were matched in age and education, for the purpose of studying its usefulness in characterizing cognitive deficits in a stroke rehabilitation population. MANOVA demonstrated significant differences (Phillai's trace, p = .007) between the stroke groups and the controls, but not between the unilateral stroke groups. Significant univariate Fs (F[2,3], p less than .05) occurred between the stroke groups and the controls in comprehension, naming, constructions, memory, and similarities. Correlations revealed strong relationships among the scales; little relationship to age was found. Education correlated with attention, comprehension, repetition, and similarities. The number of medications patients were taking did not correlate with either individual scale scores or an overall score on the NCSE. The test was found to be sensitive to cognitive effects of stroke, although there was little discrimination between left-sided and right-sided strokes. The correlational structure of the test's scales provided general support for an attention/concentration dimension, at least one general language dimension, and a general memory dimension. Further factor analytic study was recommended to more definitively assess the test's factorial dimensions. Individual descriptive data suggested that the screen and the last item of the constructions scale were too difficult. It was suggested that the item be changed or that a clue be offered to the patient.

Habituation of optically evoked blink reflex in mentally retarded adults.

This study was done to record the difference in habituation patterns of optically evoked blink reflexes in mentally retarded and normal adults. Sets of photic stimuli with fixed interstimulus duration were utilized in normal volunteers and mentally retarded adults. The interstimulus duration decreased with each sequential set. The blink responses were recorded on fibreoptic recording paper. These electrophysiological methods show objectively that the blink responses to light which habituate in normal adults fail to do so in those who are mentally retarded.

Millard-Gubler syndrome: electrophysiologic findings.

Millard-Gubler syndrome is caused by a lesion in the brainstem at the level of the facial nerve nucleus. This lesion involves the facial nerve nucleus, the abducent nerve, and the corticospinal tract. Clinical features are a weakness of all muscles innervated by the facial nerve and the lateral rectus on the involved side as well as weakness of the extremities on the contralateral side. Electrophysiologic findings are reported in this study. Conventional electrophysiologic approaches indicate a lower motor neuron type of facial involvement. Blink reflex studies indicate brainstem involvement.

Hypertension after brainstem stroke.

Paroxysmal hypertension associated with diaphoresis and facial flushing occurs after brain injury and after spinal cord lesion above the level of sympathetic outflow. This excessive sympathetic activity is due to the failure of inhibitory impulses from supraspinal vasomotor centers to reach the spinal sympathetic outflow. A case of brainstem stroke, with weakness in all four extremities, is presented. The patient experienced paroxysms of hypertension with bladder spasms, which subsided after treatment of the spasms resulting from bladder infection. Serum levels of dopamine, norepinephrine, and epinephrine were elevated during the episode and were normal after subsidence of the paroxysms.

Porous removable rigid dressing for complicated below-knee amputation stumps.

For management of complicated below-knee amputation stumps, a porous removable rigid dressing has been fabricated that can be suspended with a supracondylar cuff or with a waist belt. In addition to permitting frequent observation, eliminating the need for elastic stump bandaging, and maintaining the advantage of the conventional rigid dressing of soft-tissue immobilization to reduce the pain and prevent trauma to the stump, the porous removable rigid dressing facilitates edema reduction and wound healing, prevents moisture building, permits frequent change of dressings and promotes fast stump shrinkage.

Electrical blink reflex habituation in mentally retarded adults.

Electrophysiological methods of studying the habituation of the blink reflex have been used, to document by objective means the lack of habituation of the blink reflex in mentally retarded adults. Habituation of the blink reflex to sets of stimuli with decreasing interstimulus duration, which is fixed in each set of stimuli, has been studied in normal human volunteers and mentally retarded subjects. Habituation of direct and indirect R2 has been poor or absent in the mentally retarded subjects. The habituation indices of mentally retarded subjects do not overlap the habituation indices of the normal volunteers. In significant numbers of retarded subjects no habituation of the indirect R2 (P less than 0.00001) and of direct R2 (P less than 0.0005) was noted. No significant difference in habituation of the direct R2 and indirect R2 is noted in normal volunteers.

Glabellar reflex habituation in mentally retarded adults.

The glabellar tap reflex has been studied in 88 adults with mental retardation and 20 normal controls. None of the 20 controls had abnormal response to glabellar tap. All the subjects with mental retardation had abnormal response to glabellar tap, 80 subjects had 'no habituation' and eight subjects had 'poor habituation' of response to glabellar tap. Thirty-nine subjects, with Down's syndrome, Prader-Willi syndrome and with gross cerebral pathological states with or without motor deficits had 'no habituation' of response to glabellar tap. Of the remaining 49 subjects with unidentified aetiological diagnosis of mental retardation, 41 subjects had 'no habituation' and eight subjects had 'poor habituation' of response to glabellar tap. Age and sex had no significant effect on the response to glabellar tap in the subjects studied. The possible physiological mechanisms responsible for the abnormal response to glabellar tap have been discussed.

Autonomic pain: features and methods of assessment.

The distribution of pain originating in the sympathetic nervous system does not match the somatic segmental sensory distribution at the postganglionic level. The two types of distribution are separate and different. At the preganglionic level, fibers show typical segmental sensory distribution, which resembles but is not identical to somatic segmental sensory distribution. Instead, sympathetic pain has its own distribution along the vascular supply and some peripheral nerves. It cannot be called atypical in terms of somatic segmental sensory distribution. Several techniques are available to assess autonomic function in cases of chronic pain. Infrared thermography is superior to any other physiologic or pharmacologic method to assess sympathetic function. Overactivity of sympathetic function in the area of pain is the probable cause of temperature reduction in that area. Accordingly it would appear that in cases in which thermography demonstrates decreased temperature, sympathetic block or sympathectomy would provide relief from the pain.

Calcium balance in paraplegic patients: influence of injury duration and ambulation.

Calcium metabolic balance determinations, which have been done in various clinical and experimental conditions, were applied to the study of 8 spinal cord injured patients receiving a diet with 1600 mg calcium and 85 to 120 gm protein daily. All of the patients had hypercalciuria prior to ambulation. Those with spinal cord injuries of less than 3 months duration (early group) had a calcium balance of -27 mg before ambulation and 235 mg after ambulation. Patients with spinal cord injuries of 6 months or more duration (late group) had calcium balances of 55 mg before ambulation and 175 mg after ambulation. Ambulation significantly decreased the hypercalciuria and modified the calcium balance in a positive direction. Smaller changes were noted in the responses of the late group than in those of the early group. Early ambulation will probably prevent bone loss, calcium stones in the genitourinary tract, and other sequellae of negative calcium balance.