RESUMO
INTRODUCTION: Dysarthria is a frequent cause of handicap for patients with traumatic brain injury. Clinical assessment and quantification of the disorder is necessary before treatment. METHODS: We report a perceptual analysis of speech in a population of 18 patients with traumatic brain injury, in comparison with 18 control subjects. Evaluation was provided with a 33-item clinical scale. RESULTS: Interjuge reliability was good. Speech analysis distinguished controls from patients. Main perceptual deviances were impairment of naturalness, prosodic and phonetic disturbances.
Assuntos
Lesões Encefálicas/complicações , Disartria/diagnóstico , Disartria/etiologia , Testes de Articulação da Fala , Adolescente , Adulto , Idoso , Transtornos da Articulação/classificação , Transtornos da Articulação/diagnóstico , Transtornos da Articulação/etiologia , Disartria/classificação , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Variações Dependentes do Observador , Doença de Parkinson/complicações , Estado Vegetativo Persistente/fisiopatologia , Reprodutibilidade dos Testes , Percepção da Fala/fisiologiaRESUMO
OBJECTIVE: To characterize the dysarthria in patients with corticobasal degeneration (CBD) and determine if analysis of speech in isolation helps to distinguish CBD patients from patients with Parkinson's disease (PD). METHODS: 60 subjects were assessed by means of perceptual analysis of speech: 15 patients with CBD, 15 patients with PD and 30 control subjects. A detailed profile was furnished with the help of 33 perceptual items. A global perceptual approach was used to classify patients by judges blind to the medical diagnosis. Rating scales were adapted to quantify the degree of spasticity and hypokinesia in the speech of each patient. RESULTS: Dysarthria was frequent in CBD even though it remained mild for a long period of time. Group analysis revealed the importance of temporal errors of speech control in CBD patients while voice disturbances were most frequent in PD patients. However, attempts to classify patients according to global perceptual analysis remained below a reasonable level of clinical acceptability. Finally, even though the widespread neuropathological changes suggest that deviant speech dimensions of several types of dysarthria might be found in CBD, evidence for a mixed dysarthria with presence of spastic elements could not be established. CONCLUSION: The findings support the view that even though perceptual analysis is mandatory in the management of dysarthric patients, it does not help in the clinical differential diagnosis of CBD.
Assuntos
Disartria/diagnóstico , Disartria/etiologia , Doenças Neurodegenerativas/complicações , Doença de Parkinson/complicações , Percepção da Fala , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doença de Parkinson/diagnóstico , Medida da Produção da Fala/métodosRESUMO
INTRODUCTION: Dysarthria is frequent in Parkinson's disease and impairs communication. STATE OF THE ART: Use of levodopa or surgical procedures does not significantly improve speech. Traditional speech therapy can lead to improvement of dysarthria, and intensive programs have recently showed substantial beneficial effects on parkinsonian dysarthria. PERSPECTIVES: More work is needed to evaluate speech treatment efficacy. CONCLUSION: Earlier and more frequent speech therapy in parkinsonian dysarthria patients may contribute to better quality of life.
Assuntos
Disartria/etiologia , Disartria/terapia , Doença de Parkinson/complicações , Fonoterapia/métodos , HumanosRESUMO
Successive auditory stimulation sequences were presented binaurally to 18 young normal volunteers. Five conditions were investigated: two reference tasks, assumed to involve passive listening to couples of musical sounds, and three discrimination tasks, one dealing with pitch, and two with timbre (either with or without the attack). A symmetrical montage of 16 EEG channels was recorded for each subject across the different conditions. Two quantitative parameters of EEG activity were compared among the different sequences within five distinct frequency bands. As compared to a rest (no stimulation) condition, both passive listening conditions led to changes in primary auditory cortex areas. Both discrimination tasks for pitch and timbre led to right hemisphere EEG changes, organized in two poles: an anterior one and a posterior one. After discussing the electrophysiological aspects of this work, these results are interpreted in terms of a network including the right temporal neocortex and the right frontal lobe to maintain the acoustical information in an auditory working memory necessary to carry out the discrimination task.
Assuntos
Córtex Auditivo/fisiologia , Mapeamento Encefálico , Eletroencefalografia , Música , Percepção da Altura Sonora , Adolescente , Adulto , Ritmo alfa , Ritmo beta , Dominância Cerebral , Feminino , Lateralidade Funcional , Humanos , Masculino , Ruído , Ritmo TetaAssuntos
Transtornos de Deglutição/etiologia , Doenças do Sistema Nervoso/complicações , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/terapia , Digestão , Humanos , Mastigação , Músculos da Mastigação/fisiopatologia , Doenças do Sistema Nervoso/fisiopatologia , Faringe/fisiopatologiaRESUMO
Cortico-basal degeneration (CBD) has recently emerged as a distinctive entity of the Parkinson-plus syndromes but presents with great clinical and anatomopathological heterogeneity. The purpose of this review is to increase awareness of the syndrome and facilitate its recognition in both typical and unusual cases. We will herein review the 398 cases found in the English and French literature with their clinical, laboratory and pathological features.
Assuntos
Doenças dos Gânglios da Base/patologia , Córtex Cerebral/patologia , Degeneração Neural/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnósticoRESUMO
Perceptual analysis is widely used in clinical practice to assess motor speech disorders such as dysarthria. Unfortunately, there is no standardised tool available in French. The purpose of this study was first to develop a perceptual rating system modelled after systems currently used in the English literature and second to determine its reliability. We evaluated 33 dimensions using a 5-point scale. The production of 10 dysarthric patients were rated by 9 clinicians during both spontaneous speech and a reading task. Intra judge reliability (at 1-point) was about 90 percent, while inter judge reliability was about 80 percent. Ratings were comparable for the spontaneous speech and the reading task. Perceptual analysis of dysarthria is an easy and reproducible approach that can be used for the initial evaluation and for the follow up of dysarthric patients.
Assuntos
Disartria/diagnóstico , Inteligibilidade da Fala , Inquéritos e Questionários , Adulto , Idoso , Disartria/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Leitura , Reprodutibilidade dos Testes , Fatores de Tempo , Comportamento VerbalRESUMO
Palinacousis (auditory perseveration) is reported in a 78-year-old patient with a left temporo parietal astrocytoma. The patient complained of "echoing voice" in his right ear. Palinacousis was associated with sensitive partial seizures. Neuropsychological investigations revealed hemianacusia with normal performance for phonological discrimination and verbal repetition. We suggest that these preserved abilities allowed emergence of palinacousis.
Assuntos
Transtornos da Percepção Auditiva/etiologia , Neoplasias Encefálicas/complicações , Glioblastoma/complicações , Lobo Temporal , Idoso , Neoplasias Encefálicas/fisiopatologia , Epilepsia do Lobo Temporal/etiologia , Potenciais Evocados Auditivos , Glioblastoma/fisiopatologia , Humanos , MasculinoRESUMO
We report the naming performances of a 25 year-old woman with a left internal and inferior temporal lesion caused by herpes encephalitis who showed a preferential impairment for naming man-made objects. Evidence for category-specific effect was provided by a stepwise logistic regression using 171 pictures characterized by several parameters (words frequency, diversity of responses, length, name agreement, majoritary response, familiarity, visual complexity and canonicity). Analyses were realized over a 5 month period. Methodological considerations, anatomic correlations and arguments suggesting lexical access or semantic storage disturbance are discussed.
Assuntos
Afasia/virologia , Encefalite Viral/psicologia , Infecções por Herpesviridae/psicologia , Adulto , Feminino , Humanos , Modelos Logísticos , Análise de RegressãoRESUMO
Palinopsia (visual perseveration) and palinacousis (auditory perseveration) are reported in a 51-year-old woman with a left temporo parietal astrocytoma. EEG showed a left temporal delta-focus with sharp waves. EEG was not modified during neither palinacousis nor palinopsia. The relationship between the two hallucinatory phenomena and epilepsy is discussed.
Assuntos
Transtornos da Percepção/fisiopatologia , Neoplasias Encefálicas/complicações , Eletroencefalografia , Epilepsia/fisiopatologia , Feminino , Glioblastoma/complicações , Alucinações/fisiopatologia , Humanos , Pessoa de Meia-Idade , Transtornos da Percepção/etiologiaRESUMO
Latencies of lateral visually guided saccades were studied in 12 right handed patients who had unilateral ischaemic lesions involving the parietal lobe. The patients were divided into two groups according to the right or left side of the lesions. The severity of unilateral spatial neglect was assessed. In right parietal lesions, the asymmetry of latencies was related to the presence of unilateral spatial neglect and correlated with ist severity. According to the stimulus condition used, we suggest that the asymmetry of latency is explained in terms of an inability to disengage.
Assuntos
Lobo Parietal , Transtornos da Percepção/etiologia , Tempo de Reação , Movimentos Sacádicos , Percepção Espacial , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Humanos , Pessoa de Meia-Idade , Transtornos da Percepção/fisiopatologiaRESUMO
Perceptual analysis is not sufficient enough to identify specific dysarthria types. In order to improve the discrimination between dysarthria types, we developed a standardized evaluation of different functions controlling speech motor performances. This was applied to 90 patients suffering from hypokinetic, spastic or ataxic dysarthria and 15 control subjects. A discriminate analysis showed that 71.4 p. 100 of the cases were correctly classified. This model was validated within a new group of 21 patients and showed that the less severe dysarthric parkinsonian patients were difficult to distinguish from control subjects. The discriminate analysis was then used for 20 patients with atypical parkinsonism. Seven patients with progressive supranuclear palsy were considered to have hypokinetic dysarthria. The 6 patients with multisystem atrophy and 7 with corticobasal degeneration were classified among the 3 dysarthric types. We suggest that motor speech evaluation may contribute to differential diagnosis within groups of patients suffering from atypical parkinsonism.
Assuntos
Disartria/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Disartria/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Paralisia Supranuclear Progressiva/complicações , Paralisia Supranuclear Progressiva/diagnósticoRESUMO
We adapted in French the Frenchay Dysarthria Assessment (FDA) developed by P. Enderby in 1983. This tool quantitatively evaluates the organs involved in speech and provides a measurement of intelligibility. Productions of normal subjects were analyzed. Reproductibility of data (correlation and interobserver concordance) was high in 18 dysarthric patients. A study performed in 100 dysarthric patients corresponding to 4 types of dysarthria (spastic, ataxic, hypokinetic and mixte) showed that dysarthria resulted from a global impairment of organs implied in speech, rather than one specific organ. The reduction in the intelligibility score was related to organ impairment.
Assuntos
Disartria/psicologia , Testes de Discriminação da Fala , Inteligibilidade da Fala , Idoso , Disartria/classificação , Disartria/fisiopatologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos TestesRESUMO
We report the clinical features and neuropsychological data of chromosome-14 linked early-onset Alzheimer's disease in a large family (FAD-RO1). Information available in the literature from eight additional chromosome 14-linked Alzheimer's disease kindreds was compared with the data obtained from six kindreds with amyloid precursor protein gene mutations (APP). In the chromosome 14-linked families the disease has an earlier onset and a shorter duration than in families with APP mutations, with an age at death lower than sixty years of age. Seizures, myoclonus and extra pyramidal signs were frequently present in the cases of FAD-RO1 as in six chromosome 14-linked kindreds, but these features were absent in two other ones. The high frequency of seizures (> 80%) in FAD-RO1 and two other chromosome 14-linked kindreds is remarkable. Seizures and myoclonus were encountered at a lower prevalence in APP kindreds. This review suggests that some clinical features are more prevalent in chromosome 14-linked than in APP kindreds but a phenotypic heterogeneity does exist within and between families. The profile of deterioration of the neuropsychological performances, as illustrated by the FAD-RO1 members, shows that chromosome 14-linked kindreds do not demonstrate a specific expression in comparison to APP kindreds. Memory was first impaired. Deficits in visuo-spatial and visuopractic abilities were then noted. Finally the verbal performance deteriorated.
Assuntos
Doença de Alzheimer/genética , Cromossomos Humanos Par 14 , Adulto , Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Feminino , Ligação Genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Linhagem , FenótipoRESUMO
Complete disappearance of a cerebral arteriovenous malformation (AVM), 9 years after its discovery, is reported in a 45-year-old man. This unusual evolution was revealed by the onset of 3 seizures. CT scan and MR imaging eliminated any hemorrhage and carotid angiography showed the spontaneous thrombosis of the whole malformation. The evolution of the MRI signals demonstrates that seizures and the disappearance of the AVM were concomitant. It is suggested that the spontaneous thrombosis of the venous drainage caused the AVM disappearance with cerebral oedema responsible of seizures.
Assuntos
Malformações Arteriovenosas Intracranianas/fisiopatologia , Embolia e Trombose Intracraniana/etiologia , Epilepsia Generalizada/etiologia , Epilepsia Generalizada/fisiopatologia , Humanos , Embolia e Trombose Intracraniana/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Remissão Espontânea , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Non-bacterial thrombotic endocarditis in patients with cancer can lead to ischemic stroke. Endocardial vegetations are usually small and may be missed at transthoracic echocardiography. CASE REPORT: Disseminated intravascular coagulation developed in a woman with ischemic stroke. Transthoracic echocardiography was normal. Four days later, transesophageal echocardiography revealed a large mitral vegetation suggesting non-bacterial thrombotic endocarditis. The diagnosis was confirmed at pathology which reported carcinoma of the colon. DISCUSSION: Transthoracic echocardiography is rarely contributed to the diagnosis of thrombotic endocarditis. In our patient transesophageal echocardiography grave the diagnosis before death instead of retrospectively at autopsy as usually occurs, demonstrating the value of transesophageal echocardiography for cancer patients who develop ischemic stroke.
Assuntos
Isquemia Encefálica/etiologia , Endocardite/complicações , Trombose/complicações , Adenocarcinoma/complicações , Idoso , Isquemia Encefálica/diagnóstico por imagem , Neoplasias do Colo/complicações , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Feminino , Humanos , Trombose/diagnóstico por imagemRESUMO
BACKGROUND: Lithium salts can induce a dysfunction of the neuromuscular junction. CASE REPORT: A patient given lithium for bipolar psychosis developed a state of major fatigue revealing a myasthenia syndrome which resolved progressively after lithium withdrawal. DISCUSSION: In the literature, we found 4 cases of neuromuscular junction disorders in patients treated with lithium. A myasthenia syndrome was induced by lithium in 3 cases and underlying myasthenia was disclosed by lithium in the last one. The long-term course in our patient was in favor of an induced syndrome rather than underlying myasthenia. We discuss the pathophysiological mechanisms. Lithium is a commonly prescribed drug. Clinicians should be aware of the possibility of neuromuscular junction disorder in patients taking lithium who develop muscle fatigue.
Assuntos
Antimaníacos/efeitos adversos , Lítio/efeitos adversos , Miastenia Gravis/induzido quimicamente , Ansiolíticos/uso terapêutico , Benzodiazepinas , Transtorno Bipolar/tratamento farmacológico , Carbamazepina/uso terapêutico , Fadiga/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/induzido quimicamente , Junção Neuromuscular/efeitos dos fármacosRESUMO
Isolated palsy of the musculocutaneous nerve, terminal branch of the lateral cord of the brachial plexus, is rare. It is responsible for sensory loss of the distal forearm and weakness of elbow flexion. It occurs after shoulder or clavicle surgery, trauma (fracture, dislocation, blows on the shoulder), violent exercice or extension of the forearm, prolonged positioning of the shoulder in extension-abduction-external rotation and phlebotomy. Different mechanisms such as stretching, compression or direct nerve injury are encountered. We report 5 cases with isolated musculocutaneous nerve palsy, including bilateral palsy caused by violent forearm extension. In other cases, mechanisms were an extensive stretching during surgery and compression caused by prolonged supine position. Different injury locations and causes described in literature are reviewed.
Assuntos
Traumatismos do Braço/complicações , Mononeuropatias/etiologia , Nervo Musculocutâneo/lesões , Acidentes de Trânsito , Adulto , Feminino , Humanos , Masculino , Paralisia/etiologiaRESUMO
The authors report on a case of hypoglossal nerve palsy revealing an homolateral dissection of the internal carotid artery in the retrostyloid space. MR Imaging and MR angiography revealed the dissecting aneurysm and enabled to study its evolution.
Assuntos
Dissecção Aórtica/complicações , Doenças das Artérias Carótidas/complicações , Nervo Hipoglosso , Paralisia/etiologia , Adulto , Dissecção Aórtica/diagnóstico , Artéria Carótida Interna , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
This study was undertaken to determine the sensitivity and specificity of the transcranial Doppler (TCD) for diagnosis of vasospasm after rupture of anterior communicating artery (CoA) aneurysm. Results provided by 164 carotid angiograms and TCD measures were compared in 40 patients with CoA ruptured aneurysm. Twelve patients demonstrated a vasospasm on 22 angiographies. The distribution of angiographic vasospasm was 95.5% anterior cerebral artery (A1), 77.3% pericallosal artery (A2) and 59.1% middle cerebral artery (M1). A TCD velocity value equal or superior to 120 cm/sec was the criterion for TCD vasospasm on M1. The sensitivity of TCD on M1 for diagnosing vasospasm on M1 with high specificity (96.4%) was only 66.7%. A TCD velocity value equal or superior to 80 cm/sec, or superior to the homolateral TCD value on M1, was the criterion for TCD vasospasm on A1. The association of TCD criteria on A1 and M1 increased sensitivity to 83.3%, but specificity decreased to 75%. These results demonstrate that TCD is not yet efficient enough to diagnose vasospasm accurately when it is limited to A1. Moreover, the fact that vasospasm limited to A1-A2 was symptomatic in three patients suggests that angiography is still necessary to diagnose VS after CoA ruptured aneurysm.