Musician developed right putaminal hemorrhage but conserved absolute pitch ability -Case report.

Absolute pitch (AP) is known as the ability to recognize and label the pitch chroma of a given tone without external reference. The neural mechanism and its asymmetry of AP musicians remain unclear. We herein report a 41-year-old AP musician who developed a right putaminal hemorrhage. On a postoperative day 5, a fluid-attenuated inversion recovery image revealed the rest of the hematoma and edematous lesion at the right white matter between the Heschl's gyrus and other cortices. Diffusion tensor tractography with the region of interest at the Heschl's gyrus was performed. In the left hemisphere, the anterior part of the arcuate fiber and middle longitudinal fasciculus were observed. However, these connections were absent in the right hemisphere, but her AP ability was maintained. Our case suggested that the fibers from the right Heschl's gyrus to the right frontal lobe via the right ventral stream is not associated with AP.

Predicting walking ability in hemiplegic patients with putaminal hemorrhage: an observational study in a rehabilitation hospital.

BACKGROUND: In stroke rehabilitation, the most important concern of the patients and their families is whether the patients can walk independently and whether they need braces after discharge. AIM: This study aims to investigate the relationship between several types of putaminal hemorrhage and walking independence and orthotic therapy in patients with hemiplegia. DESIGN: Observational study. SETTING: Inpatients rehabilitation department, Fujita Health University Nanakuri Memorial Hospital, Japan. POPULATION: Total 264 patients with putaminal hemorrhage admitted to our hospital. METHODS: Neurological and cognitive functions were examined as per the stroke scale of the National Institutes of Health and the Mini-mental state examination, respectively. The hematomas were classified into five types, and the volume was measured using computed tomography (CT). Walking ability was evaluated by Functional Ambulation Category (FAC), and walking independence was defined as FAC ≥4. The relationship between the types of hematomas and walking independence and orthotic therapy in patients with hemiplegia with putaminal hemorrhage was also analyzed. RESULTS: We observed differences within the hematoma types in volume, neurological symptoms, and cognitive function but not in age, sex, and lesion side aspects of these patients - 143 of whom could walk independently (FAC≥4) and 121 non-independently. Walking independently and the need for orthosis were closely related to the type of hematoma. CONCLUSIONS: CT imaging at stroke onset can provide useful information when examining walking independence and indicate necessity for an orthosis at the time of discharge to the rehabilitation ward. CLINICAL REHABILITATION IMPACT: This study might help to better understand the role of neuroimaging in stroke rehabilitation.

Neuronavigation-Assisted Aspiration and Electro-Acupuncture for Hypertensive Putaminal Hemorrhage: A Suitable Technique on Hemiplegia Rehabilitation.

AIM: To identify whether neuronavigation-assisted aspiration (NA) combined with electro-acupuncture (EA) provides better motor recovery in events of hypertensive putaminal hematoma (HPH) sized 30 to 50 ml. This study aims to examine whether neuronavigation-assisted aspiration and electro-acupuncture have additional value to cerebral hemorrhage motor rehabilitation. MATERIAL AND METHODS: 240 patients with HPH sized 30 to 50 ml and admitted within 6 to 10 hours after stroke ictus were included in this study. Group 1 contained 60 patients who underwent neuronavigation-assisted aspiration and electro-acupuncture (NAEA), group 2 contained 60 patients who underwent neuronavigation-assisted aspiration (NA), group 3 contained 60 patients who underwent electro-acupuncture (EA), and group 4 contained 60 patients who received conservative therapy consisting solely of medications. All the patients received the same therapeutic plan on admission and functional exercises three days after stroke onset. Electro-acupuncture was performed on the third day of admission; motor recovery was examined on weeks zero and eight by blinded assessors. Outcome measures included Fugl-Meyer assessment, modified Ashworth Scale and Functional Independence Measure. RESULTS: Group one showed significantly improved motor outcomes compared to group four (p < 0.01). Group one also showed significant motor improvement when pre-and post- therapy functioning was examined (p < 0.01). Cerebral edema and ischemia were significantly decreased in group one compared to group 3 and 4 (p < 0.05). While not as effective as group one treatment, group two and group three patients had significant motor recovery after intervention when compared to group four (p < 0.05). Muscular tension secondary to stroke was considerably improved between group one and group four, group two and group four, group three and group four respectively (p < 0.05). Activities of daily living (ADL) improved a lot with EA together with NA. CONCLUSION: Neuronavigation-assisted aspiration and electro-acupuncture of HPH at the early stage can provide improved motor recovery with fewer complications. Significant motor recovery can be achieved by neuronavigation-assisted aspiration with acupuncture. Based on our findings, we recommend early intervention with NA and EA in order to promote early rehabilitation of hemiplegia secondary to HPH.

Thalamic Reorganization in Chronic Patients With Intracerebral Hemorrhage: A Retrospective Cross-Sectional Study.

The aim of this study was to investigate changes of synaptic area of the spinothalamic tract and its thalamocortical pathway (STT) in the thalamus in chronic patients with putaminal hemorrhage.Twenty four patients with a lesion in the ventral posterior lateral nucleus (VPL) of the thalamus following putaminal hemorrhage were recruited for this study. The subscale for tactile sensation of the Nottingham Sensory Assessment (NSA) was used for the determination of somatosensory function. Diffusion tensor tractography of the STT was reconstructed using the Functional Magnetic Resonance Imaging of the Brain Software Library. We classified patients according to 2 groups: the VPL group, patients whose STTs were synapsed in the VPL; and the non-VPL group, patients whose STTs were synapsed in other thalamic areas, except for the VPL.Thirteen patients belonged to the VPL group, and 8 patients belonged to the non-VPL group. Three patients were excluded from grouping due to interrupted integrity of the STTs. The tactile sensation score of the NSA in the non-VPL group (10.50 ±â€Š0.93) was significantly decreased compared with that of the VPL group (19.45 ±â€Š1.33) (P < 0.05).We found that 2 types of patient had recovered via the VPL area or other areas of the STT. It appears that patients who showed shifting of the thalamic synaptic area of the STT might have recovered by the process of thalamic reorganization following thalamic injury. In addition, thalamic reorganization appears to be related to poorer somatosensory outcome.

Recovery process and prognosis of aphasic patients with left putaminal hemorrhage: relationship between hematoma type and language modalities.

To elucidate the precise recovery process and prognosis of language functions in aphasic patients with left putaminal hemorrhage, we investigated 48 aphasic patients classified into 4 groups according to the location and extent of hematoma. The hematoma extended to the corona radiata in all patients, extracapsular in type I (12 cases), to the anterior limb in type II (10 cases), to the posterior limb in type III (12 cases), and to both limbs in type IV (14 cases). The Standard Language Test for Aphasia was performed at 1 month, 3 months, and 6 months after the attack. The type II, III, and IV patients were divided into 2 groups, with and without ventricular rupture of the hemorrhage. At 3 and 6 months after the attack, the type I, II, and III patients showed significant improvement (P < .05) in all language modalities compared with the type IV patients. Most improvement in language modalities occurred in the first 3 months. The evaluation of patients with ventricular rupture after 6 months revealed poor recovery (P < .05) in oral commands, visual commands, confrontation naming, sentence repetition, narratives, verbal fluency, and writing in type II and III patients. In type IV patients, this evaluation showed poor recovery (P < .05) only in oral and written naming (kanji words). No significant difference in prognostic outcome was observed between the surgical treatment group and the nonsurgical treatment group. The classification of hemorrhage may be useful in predicting the outcome of aphasia with putaminal hemorrhage and in guiding clinicians in providing effective instructions to patients and their relatives.

Motor outcome for patients with acute intracerebral hemorrhage predicted using diffusion tensor imaging: an application of ordinal logistic modeling.

This study examined the clinical usefulness of magnetic resonance-diffusion tensor imaging (DTI) for predicting motor outcome in patients with intracerebral hemorrhage. We studied 15 subjects (age range, 31-81 years) diagnosed by conventional computed tomography with thalamic hemorrhage, putaminal hemorrhage, or both. DTI data were obtained on days 14-18 after diagnosis. Mean fractional anisotropy (FA) values within the right and left cerebral peduncles were estimated by a computer-automated method. Using logistic regression analyses, the ratios of FA values in the affected and unaffected hemispheres (rFA) were modeled in relation to motor outcome scores at 1 month after onset, assessed using the Medical Research Council (MRC) scale (0 = null to 5 = full). The rFA values ranged from 0.628 to 1.001 (median value, 0.856). Analyses showed that the relationships between rFA and MRC scale matched the logistic probabilities for both the upper extremities (R(2) = 0.272; P < .001) and lower extremities (R(2) = 0.247; P < .001). When estimated rFA values were <0.7, the estimated probability of an MRC score of 0-1 was close to 80% for the upper extremities and 65% for the lower extremities. Meanwhile, when estimated rFA values were >0.9, the estimated probability of an MRC score of 3-5 was close to 60% for the upper extremities and 80% for the lower extremities. Our data indicate that for patients with intracerebral hemorrhage, DTI is a useful tool for quantitatively predicting motor outcome, suggesting wider clinical applicability of this method for outcome prediction.

Phoneme-based rehabilitation of anomia in aphasia.

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.

[Long-term prognosis of unilateral spatial neglect--dissociation between conventional tests and behavioral observation].

The long-term prognosis of unilateral spatial neglect (USN) in three elderly patients with stroke was investigated. Case 1 was a 62-year-old man who had suffered from right putaminal hemorrhage three years ago. Obvious right USN was found soon after the onset. After 6 months of rehabilitation he recovered and became independent in ADL without USN signs in daily circumstances. However, left USN signs appeared in some stressful situations such as traditional poetry-based competition or driving an electrical wheelchair on crowded roads. Case 2 was a 62-year-old man who had suffered from cerebral hemorrhage in the right putamen 6 years ago. He showed left USN soon after the onset, but it disappeared gradually. Cerebral infarction in the left basal ganglia occurred 6 years after the first attack. He showed decline of general attention accompanying left USN. Case 3 was a 70-year-old man who had showed left USN signs 7 years previously. He became independent and disappeared USN signs. However his activities of daily living declined gradually, and mental status became worse. Left USN signs were observed again on USN tests. Left USN was observed in three cases soon after the onset of the first stroke and then disappeared. However, USN signs became obvious in some specific situations. The appearance or disappearance of USN seemed to depend on the relationship among severity of USN, physical and mental functions, and circumstances in which USN was evaluated.