[Conduction aphasia and phonemic disorder]. / Aphasie de conduction par trouble phonémique.

Conduction aphasia is usually described as a repetition impairment. Semiology or pathophysiology cannot be explained with this definition. We report a single case particularly demonstrative. The patient showed spontaneous speech, denomination, repetition and reading impairments. Main errors were phonemic paraphasia. No arthric disorder nor comprehension impairment was observed. Damage of supramarginalis gyrus and Wernicke's area was found. A cognitive analysis suggested that the phonological buffer and the working memory were impaired. Implication for rehabilitation, which included segmentation and semantisation associated to phonological training, is discussed. The course of the conduction aphasia was good and the patient was able to work again.

[Impairment of visual recognition after a traumatic brain injury]. / Evolution des troubles de la reconnaissance visuelle à distance d'un traumatisme cérébral.

Impaired vision and cerebral blindness were observed in a patient who had suffered brain trauma. One year after the trauma, the impairment was characterized by low visual acuity, visual field restricted to central tunnel vision and impaired recognition of objects, line drawings, colors and faces. Vision improved six years after the brain trauma with more rapid recognition of objects and line drawings, increased visual acuity and broadening of the visual field. Reading was possible at this time. However, prosopagnosia remained very severe and was still the primary complaint of the patient. Improvement of visual function continuing for several years after a brain injury is discussed on the basis of cognitive and neurophysiological knowledge. The place of rehabilitation is discussed. Functional improvement is explained by extrastriate cortical afferences and the cortical network of visual pathways.

Calculation and number processing: neuropsychological assessment and daily life difficulties.

One hundred unselected brain-damaged outpatients received a standardized battery of numerical tests (EC301) and, independently, a questionnaire on numerical activities in daily life (ADL). Comparisons between the two types of measurement were drawn from the scorings for different functional components of the calculation and number processing system. Results indicated high ranking correlations between the two instruments. The EC301 battery generally proved more powerful than the questionnaire in detecting the presence of mild-to-discrete impairments, but some aspects of numerical difficulties in nonaphasic patients were scored higher on the ADL questionnaire.

Right neglect following right hemisphere damage?

From a sample of 90 stroke cases showing visual inattention following right hemisphere brain damage, 17 cases were identified who showed more inattention on the right than the left side on some tests. Eight of these subjects had CT scan-confirmed unilateral right hemisphere damage and one of these eight had MRI scan-confirmed unilateral right brain damage. A number of hypotheses are examined to explain this "paradoxical" right inattention. The most parsimonious proposes that right inattention is produced by an interaction of a compensatory left sided scanning strategy in association with a non-lateralised attentional loss.

Slowly progressive apraxia: two case studies.

Two patients with a slowly progressive and severe motor apraxia are presented. In one case, there was only apraxia; in the other there was moderate memory disturbance and a mild decline of global intellectual ability, suggesting a more widespread cognitive dysfunction. In this second case, recognition of the correct use of objects was also severely impaired, suggesting a disturbance of motor knowledge. In both cases, apraxia was asymmetrical, and associated with a contralateral atrophy of the upper parietal cortex, suggesting a differential involvement of separate action systems for each hand.

Visual recognition in right brain-damaged patients: evidence from a tachistoscopic confrontation naming task.

Right brain-damaged patients performed a confrontation naming task. Pictures were tachistoscopically presented to the right visual field and selected for their high degree of canonicity and name agreement measured in control subjects. Compared to controls, patients exhibited significant errors. Misnamings were mainly perceptual, i.e., visual-semantic or purely visual errors. No evidence of pure semantic error was found. Half of visual-semantic misnamings referred to objects of a different size (scale error) within the correct semantic field. Misnamings are tentatively attributed to a disturbance of the visual-imagistic automatic encoding process at the level of the pictorial data store.

Factors affecting the clinical measurement of visuo-spatial neglect.

The present study examined a battery of tests to evaluate unilateral spatial neglect; the tests included different tasks involving several modalities of spatial exploration mapping perceptual, motor, attentional and personal or extrapersonal space dimensions. The subjects, 121 right-brain-damaged patients with unilateral neglect, were studied in seven laboratories in four European countries. Relationships among the various tests were examined by correlations, a cluster analysis and by an analysis of individual cases. Different sensitivity was found among various tests for detecting neglect performances. Both the cluster analysis and the single case analysis clearly showed a segregation between personal and extrapersonal neglect. Analysis of the large cluster, including a variety of tests of extra personal neglect, together with the study of single cases, suggests the possibility of differentiating the various manifestations of spatial neglect which can be interpreted on the basis of the descriptions of other individual cases previously reported in the literature. Finally, the present study indicated the relative stability of neglect following the acute phase and its independence from age.

["Sub-angular" alexis and associated neuropsychologic signs: clinical and tomodensitometric study]. / Alexie "sous-angulaire" et signes neuropsychologiques associes: étude clinique et tomodensitometrique.

A clinical case of alexia without agraphia is reported. The computerized tomography (CT) showed a left sub-cortical parieto-occipital hemorrhage. The cortical lesion probably involved the posterior part of the angular gyrus but spared the medial occipital cortex. There was no evidence of a corpus callosum lesion. The clinical findings associated with the alexia and the localisation of the haematoma could be compared to the case reported by Greenblatt as a "subangular alexia" and considered as a disconnection of the left angular gyrus from right angular gyrus and both left and right occipital areas. The semiological aspects of the present case have been found to consistently differ from the classical forms of alexia usually described. Some common features with phonological alexia have been observed.

[Algodystrophic syndrome in hemiplegia. Clinical and therapeutic study]. / Le syndrome algodystrophique chez l'hémiplégique. Etude clinique et thérapeutique.

The work here exposed is divided in two studies: clinical and therapeutical. 1--Clinical. The occurrence of shoulder hand syndrome has been studied in 130 patients with hemiplegia. Although the preventive treatment was correct in all cases, 90 of them developed neurodystrophy. It is shown that the appearance and the intensity of this syndrome can be predicted with some certainly as soon as three weeks after the onset of hemiplegia, since there is a statistically significant correlation with the aetiology and the existence of some associated factors. 2--Therapeutical. The efficacy of eight treatments (calcitonin, blocking agents, intravenous clomipramine, blocking agents, periarterial injections of local anaesthetics, local or general corticotherapy, physiotherapy, kinesitherapy), randomly given to the patients, was compared (90 patients and 130 treatments). Local corticotherapy was the most efficient treatment. Physiotherapy was less efficient but always well tolerated. All the other treatments were much less active. Kinesitherapy was however always necessary to prevent joint ankylosis. No correlation was found between the intensity of the shoulder hand syndrome and the efficacy of treatments.

Facilitation of transmission in Ib pathways by cutaneous afferents from the contralateral foot sole in man.

Changes in the quadriceps H-reflex were used to study the effect of a weak contralateral cutaneous stimulation upon transmission in Ib pathways from ankle muscles to quadriceps in man. Provided it was applied to the contralateral foot sole, such a stimulation facilitated transmission in Ib pathways to quadriceps (inhibitory from extensors as well as excitatory from flexors). The central latency of this contralateral cutaneous facilitation was 1 msec longer than that of the ipsilateral cutaneous depression of Ib pathways. These findings are discussed with regard to the requirements of bipedal gait.

[The use of electrical transcutaneous nerve stimulations in chronic pain. Method and preliminary results in 28 cases (author's transl)]. / Utilisation des stimulations nerveuses transcutanées dans le traitement des syndromes douloureux chroniques. Méthode et résultats préliminaires obtenus dans 28 cas.

The analgesic effect of conventional transcutaneous nerve stimulation has been studied in 29 patients, all having a chronic pain caused by peripheral neurological disease. As already reported in the literature half of patients were improved on a short-term basis. Long-term improvement was observed mainly in patients with traumatic nerve lesions; such cases, thus appear to be the best indication for this method. It should be emphasized that whatever the etiology, the delay between the onset of pain and the beginning of transcutaneous stimulations was a critical factor. Nine out of ten patients suffering for less than one year were satisfactorily improved. This suggests that transcutaneous stimulations should be used as early as possible after the onset of neurological pain.

[Restitution of visual function in two cases of post-anoxic occipital blindness: a long term clinical study (author's transl)]. / Etude sémiologique de la restauration de la fonction visuelle dans deux cas de cécité occipitale post-anoxique.

Two cases of post-anoxic occipital blindness, one in an adult and the other in a child, are presented. A quantitative and qualitative semiological analysis was performed using tests described in a previous paper. Mechanisms underlying restitution of visual function were chronologically followed up over three years of rehabilitation. In both cases there was a noteworthy improvement in the visual function, related to the beginning of rehabilitation therapy. Five years of an almost complete cerebral blindness had preceded the improvement in case 2. Spatial construction acquisition and ontogenetic data are compared with the present data. It is suggested that there is a similar loss of activation in Broca's aphasia and cerebral visual disturbances of occipital origin.

Pattern of group I fibre projections from ankle flexor and extensor muscles in man.

Variations in the H-reflex of soleus, tibialis anterior, quadriceps and short head of biceps femoris muscles were studied in normal man, preceded by a conditioning stimulus applied to either gastrocnemius medialis, the inferior branch of soleus or the common peroneal nerve. The observed variations were evoked by low threshold afferents, had a very short latency suggesting oligosynaptic linkage and disappeared during a selective ischaemic blockade of group I fibres; they were therefore regarded as due to group I fibre stimulation. Biphasic variations were observed in almost all cases: evidence is presented that the early low threshold effects, facilitatory for synergistic and inhibitory for antagonistic motoneurone pools, are due to stimulation of Ia fibres, while the subsequent opposite effects which had a slightly higher threshold are Ib in origin. Even though the pattern of projections of group I fibres from ankle flexors and extensors is qualitatively the same in normal man as in the spinal cat, large quantitative differences are observed; in normal man the effects of group I fibres from ankle flexors and extensors upon close synergistic and direct antagonistic motoneurone pools are weak, and often negligible, whereas they are extremely potent upon quadriceps motoneurones.

Cutaneous depression of Ib reflex pathways to motoneurones in man.

Variations in the H-reflex of soleus (Sol), quadriceps (Q) and short head of biceps femoris (Bi) muscles in normal man were used to investigate the effect of volleys in low threshold cutaneous afferents from the ipsilateral limb on transmission of Ib effects from ankle and Q muscles to these different motoneurone (MN) pools. Stimulation of cutaneous afferents from the foot sole and the toes (but not from the thigh, knee or calf), which did not modify the size of the test reflexes when applied alone, strongly depressed Ib reflex pathways to MNs supplying muscles operating at the knee. The very brief central latency of this depression suggests that tactile cutaneous afferents from the foot have oligosynaptic spinal connexions with the interneurones intercalated in the Ib pathways to MNs. The same cutaneous stimuli did not all modify Ib inhibition of Sol MNs from triceps surae. These findings are discussed with regard to the role of the different muscles in human locomotion. It is suggested that during the stance phase of heel bipedal locomotion, the cutaneous depression of Ib reflex pathways to MNs supplying muscles operating at the knee might operate in association with the strong Ia connexions from ankle to knee muscles described in the previous paper.