Apraxia of speech due to the left postcentral gyrus lesion.

Key Clinical Message: Apraxia of speech (AOS) due to a postcentral infarction differs from conventional precentral AOS with respect to phonemic errors (phoneme substitution) which are more common than phonetic errors (phoneme distortion) and preserved accent and intonation. Abstract: Clinical features of apraxia of speech caused by lesions in the postcentral gyrus have not yet been elucidated. Here, we report a patient with this lesion and show how postcentral apraxia of speech differs from the hitherto known precentral apraxia of speech. A 54-year-old man developed Broca's aphasia with apraxia of speech that resolved into pure apraxia of speech within 3 weeks following infarction of the postcentral gyrus. The diagnosis of apraxia of speech was based on the patient's effortful, slow speech and inconsistent phonetic distortions with phonemic paraphasia. The Western Aphasia Battery was used to examine the patient's speech samples. Speech was recorded using a digital voice recorder and transcribed into a narrow transcription of the International Phonetic Alphabet. The error types were categorized phonologically. The results revealed that (a) phonemic errors (vowel and consonant substitutions, also known as phonemic paraphasia) were more common than phonetic errors (vowel and consonant distortions). Similar to conduction aphasia, phonemic errors were more pronounced in confrontation naming than in repetition, accompanied by self-correction, and (b) word accent and sentence intonation were preserved, although the speech was slow. These two features are characteristic of postcentral apraxia of speech, which can be differentiated from conventional precentral apraxia of speech.

Simultaneous Four Supratentorial Lesions Predict Tube Dependency Due to an Impaired Anticipatory Phase of Ingestion.

This study aimed to identify the neuroanatomical predictors of oropharyngeal dysphagia and tube dependency in patients with supratentorial or infratentorial ischemic strokes. Patients with acute ischemic stroke were enrolled and were classified into 3 groups: right supratentorial (n = 61), left supratentorial (n = 89), and infratentorial stroke (n = 50). Dysphagia was evaluated by a modified water swallowing test and the Food Intake LEVEL Scale to evaluate oropharyngeal dysphagia and tube dependency, respectively. As two dysphagia parameters, we evaluated the durations from onset of stroke to (1) success in the modified water swallowing test and to (2) rating 7 points or above on the Food Intake LEVEL Scale: patients regained sufficient oral intake and were not tube-dependent. Voxel-based lesion-symptom mapping analysis was performed for a spatially normalized lesion map of magnetic resonance imaging to explore the anatomies that are associated with the two dysphagia parameters for each stroke group. The right precentral gyrus and parts of the internal capsule are associated with oropharyngeal dysphagia. The four supratentorial areas are associated with tube dependency. The dorsal upper medulla is associated with both oropharyngeal dysphagia and tube dependency. These results suggest that supratentorial stroke patients can be tube-dependent due to an impaired anticipatory phase of ingestion. The simultaneous damage in the four supratentorial areas: the inferior part of the precentral gyrus, lenticular nucleus, caudate head, and anterior insular cortex, predicts tube dependency. In contrast, infratentorial stroke patients can be tube-dependent due to oropharyngeal dysphagia caused by lesions in the dorsal upper medulla, damaging the swallowing-related nucleus.

pH sensing using boron doped diamond electrodes.

The boron doped diamond (BDD) electrode is presented as an appropriate candidate for next generation glass-free, highly stable and accurate pH sensors. The method used in this study is based on the potential change related to the hydrogen evolution reaction following a current step, which is pH dependent. Alkali cations in the solution have no influence on the accuracy of the pH calibration curve, which provides an advantage with respect to the conventional pH glass electrode. The unwanted influence of electrochemically active compounds in solution can be avoided by adjusting the current density applied during chronopotentiometric measurements. The accuracy of the pH measurements is due to the excellent stability as well as the wide potential window and low background current of BDD electrodes. This faculty was not observed when using conventional electrode materials. The efficacy of this new type of pH sensor has been tested using tap water as a typical real sample.

Phasic reward responses in the monkey striatum as detected by voltammetry with diamond microelectrodes.

Reward-induced burst firing of dopaminergic neurons has mainly been studied in the primate midbrain. Voltammetry allows high-speed detection of dopamine release in the projection area. Although voltammetry has revealed presynaptic modulation of dopamine release in the striatum, to date, reward-induced release in awakened brains has been recorded only in rodents. To make such recordings, it is possible to use conventional carbon fibres in monkey brains but the use of these fibres is limited by their physical fragility. In this study, constant-potential amperometry was applied to novel diamond microelectrodes for high-speed detection of dopamine. In primate brains during Pavlovian cue-reward trials, a sharp response to a reward cue was detected in the caudate of Japanese monkeys. Overall, this method allows measurements of monoamine release in specific target areas of large brains, the findings from which will expand the knowledge of reward responses obtained by unit recordings.

A case of cutaneous T cell pseudolymphoma in a patient with Helicobacter pylori infection.

Cutaneous pseudolymphomas (CPL) are benign cutaneous lymphoproliferative infiltrations of various origin, including among others bacterial infections, viral infections and drugs . Helicobacter pylori has been frequently founded in the stomach of patients with MALT lymphoma. In January 2001, a 43-year-old man was referred to our department because of a 1-month history of itchy erythematous patches, plaques and flat tumors on his body. Histological examination revealed nodular infiltrations composed of lymphocytes, plasma cells and histiocytes with exocytosis of lymphocytes within the epidermis. Molecular analysis of rearrangement of T cell receptor and immunoglobulin heavy-chain genes did not reveal monoclonality. Based on these clinical, laboratory and histopathological data, a diagnosis of cutaneous T cell pseudolymphoma (CTPL) was made. The patient was anti-H. pylori antibody-positive, and was treated with anti-H. pylori combination with the result that all of the tumors had disappeared by January 2002. The patient has maintained complete response up to the last follow-up visit in December 2005.

Drug-induced hypersensitivity syndrome due to cyanamide associated with multiple reactivation of human herpesviruses.

Drug-induced hypersensitivity syndrome (DIHS), characterized by serious adverse systemic reactions in addition to skin rash, has unknown pathogenesis. Its association with human herpesvirus (HHV), mainly HHV-6, has been reported recently. A 46-year-old Japanese man is described in whom a generalized eruption developed about 1 month after taking cyanamide, a drug for alcoholism. This was associated with the following manifestations: high fever, lymphadenopathy, facial edema, marked leukocytosis with eosinophilia and atypical lymphocytes, lymphocytopenia, liver and renal dysfunction, and low IgG level. He was treated with 8 mg betamethasone daily and his condition improved, but he needed low-dose corticosteroid for almost 1 year because of several episodes of recurrence. HHV-6, HHV-7, herpes simplex virus (HSV), and cytomegalovirus (CMV) specific IgG titers showed more than a four-fold rise sequentially. Significant numbers of copies of HHV-6 and HHV-7 DNA were detected in the peripheral white blood cells by real-time polymerase chain reaction (PCR). HHV-6 and CMV DNA were detected in the serum by nested PCR. A patch test for cyanamide was positive. The diagnosis of DIHS due to cyanamide, which has never been reported as a causal drug of DIHS, accompanied by reactivation of not only HHV-6, but also HHV-7, CMV, and HSV, was made. Disturbance of the immune system was suggested by the persistent low level of IgG, and consecutive viral reactivation may have participated in the prolonged course in this case.