Lesion localization of global aphasia without hemiparesis by overlapping of the brain magnetic resonance images

Global aphasia without hemiparesis is a striking stroke syndrome involving language impairment without the typically manifested contralateral hemiparesis, which is usually seen in patients with global aphasia following large left perisylvian lesions. The objective of this study is to elucidate the specific areas for lesion localization of global aphasia without hemiparesis by retrospectively studying the brain magnetic resonance images of six patients with global aphasia without hemiparesis to define global aphasia without hemiparesis-related stroke lesions before overlapping the images to visualize the most overlapped area. Talairach coordinates for the most overlapped areas were converted to corresponding anatomical regions. Lesions where the images of more than three patients overlapped were considered significant. The overlapped global aphasia without hemiparesis related stroke lesions of six patients revealed that the significantly involved anatomi- cal lesions were as follows： frontal lobe, sub-gyral, sub-lobar, extra-nuclear, corpus callosum, and inferior frontal gyrus, while caudate, claustrum, middle frontal gyrus, limbic lobe, temporal lobe, superior temporal gyrus, uncus, anterior cingulate, parahippocampal, amygdala, and subcallosal gyrus were seen less significantly involved. This study is the first to demonstrate the heterogeneous anatomical involvement in global aphasia without hemiparesis by overlapping of the brain magnetic resonance images.

Therapeutic Application of High-Frequency rTMS Combined with Intensive Occupational Therapy for Pediatric Stroke Patients with Upper Limb Hemiparesis: A Case Series Study

Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported to significantly improve motor function of the affected upper limb in adult stroke patients with hemiparesis. For pediatric stroke patients, the beneficial effects of LF-rTMS have been already confirmed in a randomized controlled study. However, there is no report of therapeutic application of high-frequency rTMS (HF-rTMS) in this patient population. In this case series study, we introduced HF-rTMS combined with intensive occupational therapy (OT) in two pediatric hemiparetic patients. We studied two children (8- and 9-year-old boys, both right-handed) with post-stroke upper limb hemiparesis (chronic phase). Both patients underwent 22 treatment sessions of HF-rTMS/OT during 15-day hospitalization. The HF-rTMS was applied over the lesional motor cortex at a frequency of 10Hz for 15 minutes in each session. One session of intensive OT consisted of 30-min one-to-one training and 30-min self-exercise. Motor function of the affected upper limb was serially evaluated with Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Simple Test for Evaluating hand Function (STEF), and Ten-second Test. Neither of the patients showed any adverse effects. Both patients showed improvement of motor function in the affected upper limb and were able to use the affected upper limb in some activities of daily living. In the two post-stroke pediatric patients, HF-rTMS/OT was safe and improved upper limb muscle function. Confirmation of these effects in a larger population is needed.

Effects of Mirror Therapy on the Lower Limb Functionality Hemiparesis after Stroke

Introduction: Mental exercise using the mirror therapy (MT) improves the retention of newly acquired skills and the performance of sequential motor skills in subjects with post-stroke hemiparesis. Objectives: The study aimed to analyze the mirror therapy effect on the range of motion and the lower limb functionality in post-stroke hemiparesis subjects. Materials and Methods: Eleven participants with hemiparesis in the lower limb were subjected to the 10 sessions of a MT protocol. The interventions were three times per week per 30 minutes each day. Evaluation of active and passive ankle goniometry (dorsiflexion and eversion movements);Ascent and Descent Ladder Rate (ADLR);Time Up and Go test (TUG test);EFEI scale;and FAAM scale were performed. The data were collected before and after the intervention using MT, and then statistically compared. Results: The MT improved significantly (p < 0.01) the range of motion of the paretic lower limb both evaluated by active and passive ankle goniometry. An increase in the speed of gait and other functional tasks related to the paretic lower limbs were found through the TUG and ADLR tests. It also demonstrated a positive influence on the functionality of the paretic lower limb motor control through the analysis of the scores in the FAAM and EFEI scales. Conclusion: It is concluded that the MT therapy can help the patients with post-stroke hemiparesis in the improvement of several functions. Probably, the mirror therapy would aid in the repair of the injuries in the cortical areas.

Cerebral Angiography Induced Prolonged Focal Seizure and Hemiparesis during Carotid Artery Balloon Test Occlusion

The frequency of neurologic complications of cerebral angiography is 0.3%-2.3%, and the frequency of the persistent neurologic deficits that remain over 7-10 days is 0.4%-0.5%. On the other hand, all neurologic complications of balloon test occlusion (BTO) have been reported in 0%-8.3% and especially in 1.6%-1.7% of symptomatic neurologic complications. There are a few reports concerning a seizure related to cerebral angiography and BTO. We report a case of prolonged seizures and left hemiparesis during and after BTO of the right internal carotid artery. The patient showed repeated focal seizures and prolonged left hemiparesis lasting for approximately 2 months. Computed tomography and magnetic resonance imaging demonstrated no abnormal findings. Suspected mechanisms of seizure were a cerebral blood flow change induced by BTO and neurotoxicity of accumulated contrast medium. A combination of prolonged focal seizures and subsequent hemiparesis is a rare complication of BTO, which should be taken into consideration during BTO.

Implementation of an Assortment of Machine Learning Classification Algorithms Regarding Diadochokinesia for Hemiparesis with Quantification from Conformal Wearable and Wireless System

Diadochokinesia pertains to a standard aspect of the conventional neurological examination, which involves the oscillation between muscle groups with an agonist and antagonist relationship. A representative example is the pronation and supination of the forearm. Hemiparesis visibly demonstrates disparity of diadochokinesia, and clinical quantification is achieved through the use of an ordinal scale, which is inherently subjective. A conformal wearable and wireless inertial sensor equipped with a gyroscope mounted about the dorsum of the hand can objectively quantify diadochokinesia respective of forearm pronation and supination. The objective of the research endeavor was to apply an assortment of machine learning algorithms to distinguish between a hemiplegic affected and unaffected upper limb pair based on diadochokinesia with respect to pronation and supination of the forearm. Performance of the machine learning algorithms, such as the multilayer perceptron neural network, J48 decision tree, random forest, K-nearest neighbors, logistic regression, and naïve Bayes, were evaluated in consideration of classification accuracy and time to develop the machine learning model. The machine learning feature set was derived from the acquired gyroscope signal data. Using the gyroscope signal data from the conformal wearable and wireless inertial sensor the logistic regression and naïve Bayes machine learning algorithms achieved considerable performance capability with respect to both time to converge the machine learning model and classification accuracy for distinguishing between a hemiplegic upper limb pair for diadochokinesia in consideration of pronation and supination.

Recurrent Transient Ischemic Attacks Revealing Cerebral Amyloid Angiopathy: A Comprehensive Case

This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.

Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial

Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning(biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals(HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or activeassisted modes(where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan? robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off(SAT) before(T1) and immediately after(T2) training on days 1 and 2(T3 and T4). The change in SAT after 2 days of training(T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode(T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied "as-needed." This study was approved by the local ethical committee(Comité d'éthique médicale, CHU UCL Namur, MontGodinne, Yvoir, Belgium;Internal number: 54/2010, Eudra CT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov(Identifier: NCT03974750) on June 5, 2019.

Motor recovery by anterior choroidal artery territory in a patient with middle cerebral artery infarct

In this study,the uninjured periventricular area of a female patient who presented with complete paralysis of the left extremities following middle cerebral artery infarction was analyzed using diffusion tensor tractography,transcranial magnetic stimulation,and functional magnetic resonance imaging.Diffusion tensor tractography revealed interrupted corticospinal tract at the infarct lesion in the corona radiata at 2 weeks after onset,which descended through the spared periventricular area at 6 months after onset.Transcranial magnetic stimulation and functional magnetic resonance imaging revealed a motor pathway of the affected hand that was compatible with the lateral corticospinal tract.At 6 months after onset,motor function in the affected extremities recovered to normal levels,which suggested that motor function in the affected hand recovered by the corticospinal tract that passed through the spared periventricular area.The arterial territory of the spared periventricular area corresponded with the anterior choroidal artery.These results suggest that care should be taken in spared periventricular areas in patients with lesions at the corona radiata level.

Heat stroke induced cerebellar dysfunction:A “forgotten syndrome”

We report a case of heat stroke induced acute cerebellar dysfunction, a rare neurological disease characterized by gross cerebellar dysfunction with no acute radiographic changes, in a 61 years old ship captain presenting with slurred speech and gait ataxia. A systematic review of the literature on heat stroke induced cerebellar dysfunction was performed, with a focus on investigations, treatment and outcomes. After review of the literature and detailed patient investigation it was concluded that this patient suffered heat stroke at a temperature less than that quoted in the literature.

Motor recovery via aberrant pyramidal tract in a patient with a cerebral peduncle infarct

The presence of the aberrant pyramidal tract has been demonstrated by several studies; however, little is known about its role in motor recovery in stroke patients. In the present study, we reported a 69-year-old right-handed female patient with an infarct in the mid to lateral portion of the left cerebra peduncle, who showed an aberrant pyramidal tract by diffusion tensor tractography. The patient presented with severe weakness of the right extremities at stroke onset. The patient showed progressive motor recovery as much as being able to extend the affected extremities against some resistance at 6 months after onset. At 20 months after stroke onset, motor function of the left extremities had recovered to a nearly normal state. Diffusion tensor tractography results showed that the PT was disrupted at the lower midbrain of the affected （left） hemisphere at 3 weeks after stroke onset and this disruption was not changed at 20 months. An aberrant pyramidal tract in the left hemisphere was also observed, which originated from the primary motor cortex and descended through the corona radiata, posterior limb of the internal capsule, thalamus, the medial lemniscus pathway from the midbrain to the pons, and then entered into the pyramidal tract area at the pontomedullary junction. Transcranial magnetic stimulation did not elicit motor evoked potential from the affected hand muscle at 3 weeks, but it elicited motor evoked potential with mildly delayed latency and low amplitude in the affected hand muscle at 20 months. The main motor functions of the affected extremities in this patient appeared to be recovered via this aberrant pyramidal tract.

Recovery of corticospinal tract injury following subdural hematoma removal A diffusion tensor imaging study

Subdural hematoma can cause compression or damage to the neural tracts in the brain;however,very little is known about this injury.We report on a patient with subdural hematoma who was evaluated by diffusion tensor imaging prior to and after trephination and drainage of subdural hematoma.A 58-year-old male patient and ten age-matched normal control subjects were evaluated.The patient showed mild hemiparesis for 3 weeks prior to surgery.His hemiparesis recovered to a nearly normal state at 5 weeks post-surgery when the follow up diffusion tensor image was acquired.Two diffusion tensor image parameters,fractional anisotropy and apparent diffusion coefficient,were measured along the corticospinal tract.Pre-operative diffusion tensor image showed that the corticospinal tract of the affected hemisphere seemed to be injured or compressed.However,the follow up diffusion tensor image showed recovery of this corticospinal tract to a normal state.It would appear that diffusion tensor images are a useful tool for evaluation of the effects of subdural hematomas on neural tracts.

Diffusion tensor imaging of neural tract injury in a patient with hypoxic-ischemic brain injury

Hypoxic-ischemic brain injury （HI-BI） is one of the most common causes of severe neurological disability, Some studies have reported diffusion tensor imaging （DTI） findings of neonatal patients with HI-BI. However, very little is known about DTI in the adult brain. The present study reports on a 15-year-old male patient with HI-BI, who exhibited no specific focal lesions on conventional brain MRI at 5 weeks. However, neural tract injuries were revealed by DTI. Seven control subjects were also evaluated. The patient suffered from cardiac arrest due to ventricular fibrillation for a period of 10 15 minutes. At 4 weeks after onset of cardiac arrest, although he was conscious and alert, he exhibited mild quadriparesis and severe cognitive dysfunction. DTI was acquired at 5 weeks after HI-BI onset. Decreased fractional anisotropy or voxel number of neural tracts suggested partial injury of the corticospinal tract, fornix, and cingulum. Disruptions of the fornix and cingulum on DTI confirmed neural tract injury. DTI could serve as a useful tool for evaluating the state of neural tracts in patients with HI-BI.

Hemichorea due to ipsilateral thalamic infarction: A case report

BACKGROUND Hemichorea usually results from vascular lesions of the basal ganglia.Most often,the lesion is contralateral to the affected limb but rarely,it may be ipsilateral.The pathophysiology of ipsilateral hemichorea is still poorly understood.We review the literature on hemichorea due to ipsilateral cerebral infarction and explore possible mechanisms for its occurrence.CASE SUMMARY A 72-year-old woman presented with complaints of involuntary movements of the muscles of the left side of the face and mild weakness of the right limbs.Her symptoms had started suddenly 1 d earlier.After admission to the hospital,the involuntary movements spread to involve the left limbs also.Magnetic resonance imaging revealed a left thalamic infarction.The patient’s hemichorea subsided after treatment with haloperidol(2 mg per time,3 times/d)for 3 d;the hemiparesis resolved with rehabilitation physiotherapy.She is presently symptom free and on treatment for prevention of secondary stroke.We review the literature on the occurrence of ipsilateral hemichorea following thalamic infarction and discuss the possible pathomechanisms of this unusual presentation.CONCLUSION Ipsilateral hemichorea following a thalamic stroke is rare but it can be explained by structure of the extrapyramidal system.The thalamus is a relay station that exerts a bilateral control of motor function.

The mechanism and clinical effectiveness of the six-step Chinese Daoyin technique on hemiplegic patients with drop-foot

Objective: The aim of this study was to improve the Chinese Daoyin technique (physical and breathing exercises), which is an ancient rehabilitation method, to elevate its effect and to standardize its operational procedure. Methods: Based on the ancient Chinese Daoyin technique, a six-step method was developed including: 1) motion imagination and imitation;2) mental and breathing regulation;3) target point determination;4) motion percussion;5) motion persistence;6) relaxation. Sixty drop-foot patients who suffered from hemiparesis after a stroke were randomly divided into the experimental group and the control group. Functional evaluation including Fugl-Meyer assessment score, Lovett manual muscle test (MMT), active range of motion of the ankle joint and electromyography were performed before and after the training course. The data were analyzed using the statistical software SPSS 12.0. Results: The differences between the two groups were significant. The effectiveness of the six-step group was significantly better than the effectiveness of the control group. Conclusion: The six-step method of the Chinese Daoyin technique is an effective rehabilitation training method for drop-foot in stroke patients with hemiparesis.

Longitudinal Evaluation of Hemiplegic Ankle Rehabilitation Efficacy by Wearable Inertial Sensor Systems with an Assortment of Machine Learning Algorithms

With the amalgamation of wearable systems equipped with inertial sensors, such as a gyroscope, and machine learning a therapy regimen can be objectively quantified, and then the initial phase and final phase of a one year therapy regimen can be distinguished through machine learning. In the context of rehabilitation of a hemiplegic ankle, a longitudinal therapy regimen incorporating stretching and then a series of repetitions for raising and lowering the foot of the hemiplegic ankle can be applied over the course of a year. Using a smartphone equipped with an application to function as a wearable and wireless gyroscope platform mounted to the dorsum of the foot by an armband, the initial phase and final phase of a one year longitudinally applied therapy regimen can be objectively quantified and recorded for subsequent machine learning. Considerable classification accuracy is attained to distinguish between the initial phase and final phase by a support vector machine for a one year longitudinally applied hemiplegic ankle therapy regimen based on the gyroscope signal data obtained by a smartphone functioning as a wearable and wireless inertial sensor system. .

Risk factors for bad outcome in pediatric epidural hematomas:a systemic review

Background:Pediatric epidural hematomas(EDH)represent a neurosurgical emergency.Both surgical and conservative treatment can lead to a good clinical outcome.The aim of the study was to review our series of pediatric EDH and to determine the clinical and radiologic factors,which can influence the final outcome.Methods:All children aged from 0 to 16 that have been treated between 2013 and 2017 for cranial EDH have been selected.Results:Thirty children have been included in the study.Seventeen cases have been treated with surgical evacuation and 13 conservatively.Six months after the trauma,the outcome was excellent(mRS 0)in 25/30(83.3%)cases,mild deficits(mRS 1-2)were present in 4/30(13.3%),and severe deficits(mRS 3-5)in 1/30(3.3%)cases.Only a GCS(Glasgow Coma Scale)below 8 at admission was significantly related to the presence of a neurologic deficit at 6 months(p=0.048).Conclusions:EDH can be managed with excellent outcomes.Even in the presence of bad initial clinical and radiologic conditions,a correct treatment strategy can lead to a good recovery.In our series,only a GCS below 8 at admission was significantly related to the presence of neurological sequelae.

Treatment Strategy for Middle Cerebral Artery Dissecting Aneurysm with Severe Stenosis

A 62-year-old male patient was presented to the First Affiliated Hospital,Zhejiang University,School of Medicine with right hemiparesis and aphasia.No obvious infections were found.The magnetic resonance imaging demonstrated multiple infarctions in the area supplied by the left middle cerebral artery.The diagnosis was made as left middle cerebral artery dissecting aneurysm with stenosis.After adequate preoperative preparation,the patient received interventional therapy and then exhibited good prognosis.This paper introduces the interventional procedures for the treatment of the left middle cerebral artery dissecting aneurysm with stenosis.