Keep an Eye on the Intracranial Pressure, Thanks to the Optic Nerve Sheath Diameter.

Neurological examination on sedated patients is challenging and no gold standard monitoring is currently available. We report the case of a patient deeply sedated for the management of acute respiratory distress syndrome secondary to pneumonia. Delay in awakening led to cerebral exploration by transcranial Doppler (TCD) and measurement of optic nerve sheath diameter (ONSD). Abnormal values of ONSD prompted immediate brain computed tomography scan that confirmed high intracranial pressure (ICP) due to multiple deep parenchymal hematomas. Despite raised ICP, values obtained by TCD were normal, thanks to the persistence of cerebral autoregulation. This case highlights the interest of combining noninvasive techniques for neurological examination, especially for sedated patients.

Preparation of an intensive care unit in France for the reception of a confirmed case of Ebola virus infection.

The current Ebola Virus Disease (EVD) outbreak in West Africa is a major challenge for the worldwide medical community. On April 29th 2015, the World Health Organization (WHO) declared 26,277 infected cases; among them, 10,884 have deceased. The epidemic is still ongoing, particularly in Sierra Leone. It is now clear that northern countries will be implicated in the care of EVD patients, both in the field and back at home. Because of the severity of EVD, a fair amount of patients may require intensive care. It is highly probable that intensive care would be able to significantly reduce the mortality linked with EVD. The preparation of a modern Intensive Care Unit (ICU) to treat an EVD patient in good conditions requires time and specific equipment. The cornerstone of this preparation includes two main goals: treating the patient and protecting healthcare providers. Staff training is time consuming and must be performed far in advance of patient arrival. To be efficient, preparation should be planned at a national level with help from public authorities, as was the case in France during the summer of 2014. Due to the severity of the disease, the high risk of transmission and scarce knowledge on EVD treatment, our propositions are necessarily original and innovative. Our review includes four topics: a brief report on the actual outbreak, where to receive and hospitalize the patients, the specific organization of the ICU and finally ethical aspects.

Treatment of metaphor interpretation deficits subsequent to traumatic brain injury.

OBJECTIVE: To improve oral interpretation of metaphors by patients with traumatic brain injury (TBI). DESIGN: Both single subject experimental design and group analysis. SETTING: Patients' homes. PARTICIPANTS: Eight adult patients with moderate to severe traumatic brain injury sustained 3 to 20 years before testing. INTERVENTION: The Metaphor Training Program consisted typically of 10 baseline sessions, 3 to 9 1-hour sessions of structured intervention, and 10 posttraining baseline sessions. Training used extensive practice with simple graphic displays to illustrate semantic associations. MAIN OUTCOME MEASURES: Quality of orally produced metaphor interpretation and accuracy of line orientation judgments served as dependent measures obtained during baseline, training, posttraining, and at a 3- to 4-month follow-up. Untrained line orientation judgments provided a control measure. RESULTS: Group data showed significant improvement in metaphor interpretation but not in line orientation. Six of 8 patients individually demonstrated significant improvement in metaphor interpretation. Gains persisted for 3 of the 6 patients at the 3- to 4-month follow-up. CONCLUSION: The Metaphor Training Program can improve cognitive-communication performance for individuals with moderate to severe traumatic brain injury. Results support the potential for treating patients' residual cognitive-linguistic deficits.

A MEG investigation of single-word auditory comprehension in aphasia.

PURPOSE: To explore whether individuals with aphasia exhibit differences in the M350, an electrophysiological marker of lexical activation, compared with healthy controls. METHOD: Seven people with aphasia, 9 age-matched controls, and 10 younger controls completed an auditory lexical decision task while cortical activity was recorded with magnetoencephalography. There were 2 stimulus conditions of interest: identity primed (i.e., a word preceded by itself) and semantic primed (i.e., a word preceded by a semantically related word). Latency and amplitude of the M350 response as well as reaction time were measured. RESULTS: Consistent with the age-matched control group, the group with aphasia showed both identity and semantic priming behaviorally. In contrast to the control groups, the group with aphasia did not show either semantic or identity priming of the M350 response. This group also demonstrated longer M350 latencies than either control group. Furthermore, within this group, M350 latency was positively correlated with a measure of semantic impairment. CONCLUSIONS: These findings highlight the usefulness of temporally sensitive measures when studying aphasia and demonstrate that the latency of electrophysiological markers is of interest in this population. In particular, increased M350 latency appears to be indicative of a semantic processing impairment.

Treating Metaphor Interpretation Deficits Subsequent to Right Hemisphere Brain Damage: Preliminary Results.

PURPOSE: This investigation sought to determine whether a structured intervention focused on improving use of semantic associations could improve patients' ability to provide oral interpretations of metaphors following Right Hemisphere Damage (RHD). METHODS: Principles of single subject experimental design provided the basis for the study. Five patients received either 10 or 20 baseline assessments of oral metaphor interpretation and, as a control, assessments of line orientation skill. They then received approximately 10 one-hour sessions of structured intervention to improve oral metaphor interpretation followed by post-training assessments and a 3 month follow up. RESULTS: Patients' performances revealed evidence of good response to training as shown by patients' ability to reach criterion on all intervention tasks and by their significant improvement on oral metaphor interpretation. There was relatively little improvement on the line orientation task. DISCUSSION: The results of this study support the clinical usefulness of this new approach to treating communication deficits associated with RHD due to stroke, even years post-onset. There are, however, questions that remain unanswered. For example, additional data will be needed to gauge how a patient's severity of impairment relates to the potential for improvement, to chart the durability and scope of improvement associated with the training, and to determine the type of visuospatial ability needed for using this type of pictorial material.

Translational research in aphasia: from neuroscience to neurorehabilitation.

PURPOSE: In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005. METHOD: In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles. CONCLUSION: Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.