Childhood ischaemic stroke in the basal ganglia can lead to fine motor and anxiety disorders: a retrospective analysis and follow-up of 109 cases.

BACKGROUND: Stroke in children easily causes long-term dysfunction. Whether the prognoses of motor and anxiety disorders are related to the affected stroke area has not been reported. METHODS: One hundred nine cases of children with ischaemic stroke were reviewed and divided into three groups: lenticular nucleus lesions only (lenticular nucleus group), lenticular nucleus and caudate head lesions (caudate head group), and lenticular nucleus and thalamus lesions (thalamus group). Overall prognosis was evaluated by the mRS score. The SCAS-P was used to evaluate anxiety in children aged ≥6 years. RESULTS: mRS scores were ≤ 2 points (mean: 0.62), no significant difference among groups. 3/21 (14.2%) patients in the caudate head group changed handedness, which is significantly higher than other groups. Patients with lesions in thalamus group had significantly higher SCAS-P scores. CONCLUSIONS: The overall prognosis of children with basal ganglia ischaemic stroke is good. However, hand preference changes and anxiety disorders may develop. Patients in the caudate head groups are more likely to suffer from fine motor disorders and changes in handedness. Patients within the thalamus group are more prone to anxiety than patients in the other groups. Anxiety disorders should be noted in children with basal ganglia stroke.

Post-stroke memory impairment among patients with vascular mild cognitive impairment.

BACKGROUND: The American Stroke Association/American Heart Association recommended the criteria for diagnosis of vascular cognitive impairment and memory impairment (MI) is a feature in the classification of vascular mild cognitive impairment (VaMCI). VaMCI patients with MI may differ in terms of infarct location or demographic features, so we evaluated the clinical characteristics associated with MI in patients with VaMCI. METHODS: A prospective multicenter study enrolled 353 acute ischemic stroke patients who underwent evaluation using the Korean Vascular Cognitive Impairment Harmonization Standard Neuropsychological Protocol at three months after onset. The association between MI and demographic features, stroke risk factors, and infarct location was assessed. RESULTS: VaMCI was diagnosed in 141 patients, and 58 (41.1%) exhibited MI. Proportions of men and of left side infarcts were higher in VaMCI with MI than those without (75.9 vs. 57.8%, P = 0.03, 66.7 vs. 47%, P = 0.02). Multiple logistic analyses revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [95% CI] 1.12-8.42), left-side infarcts (OR 3.14, 95% CI 1.37-7.20), and basal ganglia/internal capsule infarcts (OR 4.53, 95% CI 1.55-13.22) were associated with MI after adjusting other demographic variables, vascular risk factors, and subtypes of stroke. CONCLUSIONS: MI is associated with sex and infarct location in VaMCI patients.

Effect of micro lesions of the basal ganglia on ballistic movements in patients with deep brain stimulation.

Bradykinesia and hypokinesia are the prominent symptoms of substantia nigra degeneration in Parkinson's disease (PD). In segmental dystonia, movements of not affected limbs are not impaired. Here we studied the impact of the mere implantation of stimulation electrodes on the performance of fast movements in these two groups. We investigated 9 PD patients with subthalamic electrodes and 9 patients with segmental dystonia with electrodes in the globus pallidus internum. Patients were studied on the first postoperative day without electrical stimulation of the electrodes. Subjects had to perform boxing movements with either touching the target or stopping the fist in front of the target. PD subjects performed significantly faster movements in the touch-task only as compared to dystonic patients. No difference was seen in the stopping task. In conclusion, our findings suggest that a small subthalamic lesion in individuals with PD specifically reverses bradykinesia during simple ballistic movements (touch) but not during complex ones requiring more pre-programming (no-touch paradigm).

Emotional incontinence and executive function in ischemic stroke: a case-controlled study.

Frontal and basal ganglia infarcts and executive dysfunction are thought to be involved in the pathophysiology of poststroke emotional incontinence (PSEI). The study examined whether patients with PSEI have more frontal and/or basal ganglia infarcts and impairment in executive function. A total of 516 Chinese patients with acute ischemic stroke consecutively admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were screened for PSEI 3 months after the index stroke. According to Kim's criteria, 39 (7.6%) had PSEI. Thirty-nine stroke patients without PSEI served as matched control group. The PSEI group had significantly more frontal and/or basal ganglia infarcts, had lower Chinese Frontal Assessment Battery scores, required more time to complete the Stroop Test, and made more omission and commission errors in the Go-NoGo test. There was no significant correlation between frontal or basal ganglia infarcts and executive function. The correlation between frontal infarct and severity of PSEI was .420. Further follow-up and functional imaging studies are warranted to explore the relationship between PSEI, brain infarcts, and executive dysfunction. (JINS, 2009, 15, 62-68.).

Virchow-Robin space dilatation may predict resistance to antidepressant monotherapy in elderly patients with depression.

BACKGROUND: Late-life depressive disorders have been linked to cerebrovascular disease (the vascular depression hypothesis). Treatment resistance may be associated with vascular-based lesions in the white matter and basal ganglia. Virchow-Robin spaces (VRS) are cerebrospinal fluid spaces associated with microangiopathy of small cerebral vessels. This study tested the hypothesis that dilation of Virchow-Robin spaces seen on Magnetic Resonance Imaging (MRI) is associated with treatment resistance in elderly depressed individuals. METHODS: 50 patients with late-onset (age over 60 years) major depressive disorder (29 responders to monotherapy, 21 non-responders to monotherapy) and 35 normal volunteers were recruited. Assessment of deep white matter lesions [WML] and periventricular hyperintensities [PVH] (both with the Scheltens rating scale score, [Scheltens, P., Barkhof, F., Leys, D., et al. (1993) A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. J Neurol Sci;114(1):7-12.]) and the severity of VRS dilatation (using a new scale) were scored from MRI images. Statistical group comparisons and multiple regression analyses were performed to quantify the relationship between imaging features and clinical outcome. RESULTS: There was a trend for greater WML Scheltens scores in the monotherapy resistant group compared to responders and control subjects, but only using the basal ganglia VRS score was there a statistically significant difference. A score of 2 or greater on the VRS score was 80% sensitive and 62% specific in predicting non-response to antidepressant monotherapy. The VRS score accounted for 38% of the variance in the multiple regression model and the PVH score, which was an independent predictor of outcome, contributed another 6%. LIMITATIONS: Numbers are small and type II errors possible, especially for the Scheltens ratings. Treatment response was limited to response or non-response to monotherapy and was retrospectively derived. The VRS scale was originally designed for use in patients with vascular dementia and has not been used before in affective disorders. Although all depressed subjects were late-onset, it is possible that depression led to vascular disease rather than vice versa. CONCLUSION: VRS dilatation is common in diseases associated with microvascular abnormality, which is the presumed basis of vascular depression in the elderly. VRS score may be useful in determining which patients are less likely to respond to antidepressant monotherapy. Prospective studies of patients with a wider range of treatment responses are indicated.

Changes in cognitive function after neuronal cell transplantation for basal ganglia stroke.

Reported is the change in cognitive function after neuronal cell transplantation as a treatment for basal ganglia stroke. Nine subjects (two controls, seven transplants), all over 2 years post stroke, completed a comprehensive neuropsychological test battery prior to and 6 months after treatment. Four transplanted subjects who had strokes in the nondominant hemisphere showed marked improvement on the Rey Complex Figure, a test of visuospatial/constructional ability and nonverbal memory.

Predictors of home health care services for cerebral vascular disease patients in Taiwan.

The National Health Insurance in Taiwan has rigid regulations for reimbursing home nursing care with payment only for technical/skill care such as changing nasogastric tubes, urine catheters, and tracheal tubes, wound care, and specimen collection. Patients with chronic illnesses who reside at home, however, require care that is holistic and focuses on wellness rather than illness. Cerebral vascular disease (CVD) patients are the largest group receiving home nursing care. They qualify for reimbursement under NHI. The purposes of this study were to quantify the home health care (HHC) needs of CVD patients and to understand predictors for HHC services for CVD patients in Taiwan. A descriptive correlation design was used to examine the relationship between a CVD patient's health status and the need for HHC services. In total, 195 patients were interviewed by one trained research assistant, with 124 patients being from Taipei (an urban area in Taiwan) and the remaining 71 from I-lan (a rural area in Taiwan). The mean age of subjects was 74.8 years, with 60% of the sample being female. Physiological health status scores (M = 2.56, SD = 0.58, range = 1-5) were worse than the psychosocial health status scores (M = 2.37, SD = 0.91, range = 1-5), which indicates that the need for health education and skilled nursing services was higher than referral services for professional HHC services. Results suggest that there is a need to develop and shape NHI policy to cover more holistic HHC services for CVD patients.

Disentangling the web: neologistic perseverative errors in jargon aphasia.

This article explores the relationship between the neologisms and perseverative errors produced by KVH, a man with severe neologistic jargon aphasia. Detailed examination of KVH's level of language processing breakdown revealed mild difficulties with phonological encoding and severe difficulties accessing the lexical form of the word. Many of KVH's neologisms contained phonemes perseverated from previous neologisms, suggesting an integral relationship between the production of neologisms and the perseveration of phonemes. Furthermore, KVH's patterns of whole word (total)and phonological (blended) perseverations reflected his proposed underlying language processing deficits, consistent with recent literature on perseveration (e.g.,Cohen and Dehaene, 1998). However, the simple binary distinction oftotalandblendedperseveration is proposed to be somewhat limited for understanding the underlying nature of KVH's complex neologistic errors. Possible explanations regarding the mechanisms underlying the production of KVH's neologistic and perseverative errors also are discussed.

Inhibition of ongoing responses following frontal, nonfrontal, and basal ganglia lesions.

The authors investigated the role of the frontal lobes and the basal ganglia in the inhibition of ongoing responses. Seventeen patients with frontal lesions (FG), 20 patients with lesions outside the frontal cortex (NFG), 8 patients with lesions to the basal ganglia (BG), and 20 orthopedic controls (OG) performed the stop-signal task that allows the estimation of the time it takes to inhibit an ongoing reaction (stop signal reaction time [SSRT]). The FG and the BG showed significantly longer SSRTs than the OG. Within the FG, patients with right and bilateral lesions showed significantly longer SSRTs than patients with left lesions. Results provide evidence for a role of the frontal lobes and the basal ganglia in the inhibition of ongoing responses.