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Introduction. Alexia without agraphia is an impairment of reading ability. Speech, auditory comprehension, repetition and writing are relatively intact. Due to a damage of the splenium of corpus callosum, alexia without agraphia is considered to be an interhemispheric disconnection syndrome. Case Report. We presented a 71-year-old male, with chronic hypertension, diabetes mellitus and dyslipidemia. The magnetic resonance imaging showed a lesion in the left medial temporal region, including the equilateral thalamus, posterior cingulate gyrus, splenium of corpus callosum, lingual occipital gyrus, and the tail of the hippocampus. Lacunar ischemia was found on the right side of cerebellum. The neuro-linguistic diagnostic protocol included the Mini Mental State Examination, Boston Diagnostic Aphasia Examination, Boston Naming Test and phonemic and category fluency tests. We have also designed a clinical protocol for color recognition assessment. The results showed a mild cognitive impairment related to the time and space orientation, delayed memory and reading. On the speech and language levels, a severe acquired alexia without agraphia was registered which was not associated with other language modalities. Conclusion. The neuro-linguistic tests and clinical techniques provide a rather reliable diagnostic criteria, which is the basis for neuro-rehabilitation. The rehabilitation protocol refers to training techniques: tactile-kinesthetic recognition of graphemes and application of various reading techniques, such as letter-by-letter reading, Multiple Oral Re-reading, melodic intonation therapy and oral reading technique in order to facilitate rehabilitation of reading. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Subcortical white matter (WM) plays an important role in speech production and language processing. Most frequently, cerebral WM lesions are secondary to small vessel disease in patients with vascular risk factors. We report the case of a 53-year-old man with history of hypertension and ischemic subcortical lesions, who presented with speech difficulties and mild cognitive impairment. Methods: Language and cognitive assessment included Boston Diagnostic Aphasia Examination, Boston Naming Test, Rey Auditory-Verbal Learning Test, Rey-Osterrieth Complex Figure Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Scale for Evaluation of Perceptive Characteristics of Voice and Speech, and Multidimensional Evaluation of Speech and Voice. Results: Brain MRI showed ischemic WM lesions and lacunar infarcts in the brainstem and right cerebellum. Cognitive testing revealed mild cognitive impairment, predominantly affecting attention and executive functions. Speech and language analysis demonstrated dysarthria, dysphonia with hypophonia, and imprecise articulation, as well as short rushes of speech, palilalia and mild subcortical dysphasia. Conclusions: Neurolinguistic and acoustic analysis in patients with ischemic WM lesions can provide additional information in the understanding of language and speech disturbances, and can assist in patient management. [Copyright &y& Elsevier]

Background/Aim. Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80-100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. Methods. The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12-16 units each. In our study we applied indirect technique originally developed by Hočevar and Pirtošek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. Results. The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index -- (VHI) that was rated as rather significant one (t = 3.562; p = 0.006). Conclusion. Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation. [ABSTRACT FROM AUTHOR]

Introduction. Cerebral small vessel disease is a neurological condition characterized by motor, cognitive and affective disorders, often found on brain magnetic resonance imaging scans in patients with vascular risk factors. Affective disorders may have a major impact on patients’ quality of life, although they are often ignored as an entity in cerebrovascular pathology. Material and Methods. This prospective study included 80 patients with the diagnosis of cerebral small vessel disease admitted at the Clinic of Neurology, Clinical Center of Serbia in the period from January 1, 2017 to January 1, 2019. Baseline demographic data and brain magnetic resonance findings were obtained along with the results of cognitive function and affective status tests. Data were analyzed using standard statistical tests. Results. Standard screening tests revealed that 51.25% and 33.75% of our patients with cerebral small vessel disease suffer from apathy and depression, respectively. A significant correlation was found between the severity of white matter changes on magnetic resonance scans and apathy (p = 0.0092). Additionally, white matter changes were also significantly associated with depression (p = 0.021). Conclusion. Affective disorders are not uncommon in cerebral small vessel disease and apathy was the leading phenomenon among our patients. Since a strong correlation was detected between affective disorders and severity of vascular changes on magnetic resonance scans, we may conclude that both apathy and depression are key features of an underlying brain injury, rather than just comorbidity. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Although typically linked to aging, small vessel disease (SVD) is also observed in younger adult patients, with common vascular risk factors (RF). We aimed to investigate features of SVD occurrence at an early adult age. Patients and methods: Vascular RF, functional and cognitive status and severity of lesions on MRI expressed as total score on Age-Related White Matter Changes (ARWMC) scale were analyzed in 200 consecutive patients with cerebral SVD admitted to a tertiary neurological hospital. Variables were compared between younger (35–55 years) and older (>56 years) patients. Results: In this study, 63 (31.5%) of patients were 55 years or younger. Both age groups had comparable RF profiles, but smoking emerged as an independent predictor for SVD at a younger age (OR 2.9; 95% CI 1.5–5.5; p =0.002). Younger patients had better functional (OR 1.8; 95% CI 1.3–2.5; p =0.0001) and cognitive (χ 2 13.94; p =0.0009) status compared to older patients. However, two thirds of younger patients had some degree of cognitive deficit. Total score on ARWMC scale was lower in younger patients (mean 12.3 in younger versus 15.2 in older, OR 1.11; 95% CI 1.0–1.18; p =0.001). There was a strong correlation in both groups between functional score, cognitive status and ARWMC score (p <0.0001). Conclusion: In our dataset, younger patients with SVD shared common vascular RF with older patients. In the group aged ≤55, better functional and cognitive status and less severe MRI changes were noted. However, a substantial number of younger SVD patients presenting with TIA or ischemic stroke had various deficits. [Copyright &y& Elsevier]