Vascular aphasia outcome after intravenous recombinant tissue plasminogen activator thrombolysis for ischemic stroke.

INTRODUCTION: No data about the specific outcome of aphasia after thrombolysis are available. Our aim was to describe the severity and type of aphasia after stroke thrombolysis. METHODS: This retrospective cohort study included consecutive aphasic patients hospitalized in the Stroke Unit of Dijon (University Hospital, France) between 2004 and 2009 for a first-ever ischemic stroke of the left middle cerebral artery. Aphasic syndromes and their severity (French version of the Boston Diagnostic Aphasia Examination) were evaluated during the first week and 3 months after stroke. RESULTS: In multivariate analyses, the severity of aphasia in the 37 thrombolysed patients was milder than in the 38 nonthrombolysed patients during the first week (adjusted OR = 10.13, 95% CI: 2.43-42.28, p = 0.002) and at 3 months (adjusted OR = 8.44, 95% CI: 2.76-25.80, p = 0.001). The frequency of mild aphasia (conduction or atypical) was not significantly higher in thrombolysed patients during the first week after stroke (adjusted OR = 5.80, 95% CI: 0.82-41.16, p = 0.079). CONCLUSION: The severity of aphasia during the first week and 3 months after stroke is milder in thrombolysed than in nonthrombolysed patients, perhaps because of a greater frequency of conduction and mild atypical aphasia.

[Semantic dementia: reflexions of a French working group for diagnostic criteria and constitution of a patient cohort]. / Démence sémantique: réflexions d'un groupe de travail pour des critères de diagnostic en français et la constitution d'une cohorte de patients.

Semantic dementia (SD) is a syndrome of progressive loss of semantic knowledge for objects and people. International criteria propose that SD be included in the frontotemporal lobar degeneration syndromes, with progressive non-fluent aphasia and frontotemporal dementia (FTD). However, several related syndromes have been defined that clinically and conceptually share both similarities and differences with SD: fluent progressive aphasia, progressive prosopagnosia, temporal variant of FTD. In order to establish a French consensus for the diagnosis and modalities of evaluation and follow-up of SD, a working group, composed of neurologists, neuropsychologists and speech-therapists, was established by the Groupe de réflexion sur les évaluations cognitives (GRECO). New criteria were elaborated, based on clinical, neuropsychological, and imaging data. They define typical and atypical forms of SD. A diagnosis of typical SD relies on an isolated and progressive loss of semantic knowledge, attested by a deficit of word comprehension and a deficit of objects and/or people identification, with imaging showing temporal atrophy and/or hypometabolism. SD is atypical if the deficit of semantic knowledge is present only within a single modality (verbal versus visual), or if non-semantic deficits (mild and not present at onset) and/or neurological signs, are associated with the semantic loss.

[Functional hemispheric arousal and egocentric reference. An experimental study in 20 normal subjects]. / Activation fonctionnelle hémisphérique et référence égocentrique. Etude expérimentale chez 20 sujets normaux.

The aim of this study was to evaluate the influence of each hemispheric functional arousal (right or left) on the designation of a subjective egocentric reference. The subjective designation of a egocentric reference was measured and compared in 20 right-handers healthy volunteers in cognitive tasks concerning either the right or the left hemisphere. The location of the egocentric reference was different during right or left hemispheric arousal. The hemispheric arousal induce a displacement of the egocentric reference to the contralateral space. These results are compared with clinical and neurophysiological studies and suggest new explorations to the mechanisms of heminegligence.

[Crossed alexia-agraphia in a right-handed patient]. / Alexie-agraphie croisée chez un droitier.

A right-handed man, born of a right-handed family, presented an infarct in the territory of the right middle cerebral artery, with a left hemiplegia, a left lateral homonymous hemianopsia and an expression aphasia. The oral trouble disappeared in some weeks, but later a permanent linguistic deficit persisted, affecting mainly the written language and realizing a clinical picture of alexia-agraphia with Gerstmann's syndrome. The neurolinguistic study showed a preferential alteration of the phonologic system in the written language, and at a lesser degree in the oral modality. The extent of the lesion and the relative integrity of oral expression and comprehension, suggested that these functions were localized in the left hemisphere, whereas lecture, writing, calculation, body-parts notion, laterality notion, had been simultaneously implanted during the ontogenesis in the right hemisphere. The latter was probably also responsible for phonological aspects of written and spoken language, according to a scheme opposite to that of usual right-handers.

[Writing disorder using a word processor: role of the left hand]. / Trouble de l'écriture sur traitement de texte: rôle de la main gauche.

A young female secretary developed a writing disorder, exclusively expressed when using a word processor, following an ischemic vascular event involving the insula and the right posterior parietal region. There was no disturbance of laterality. The neurological examination, completed by neuropsychological tests eliminated any persistent phasic or gnostic disorders. The analysis of the text produced revealed abnormalities leading to the conclusion that the left hand was responsible for all the errors observed. A sensorimotor integration disorder produced a melokinetic apraxia which appeared to be the cause of the writing disorder which would have most likely remained unknown had the subject not been a secretary.