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Background: Neurophysiological monitoring (NPM) is frequently performed during arteriovenous malformation (AVM) embolization. However, the ability of NPM to predict neurological deficits or improve surgical decision making in this setting has not been studied., Objective: To review our use of NPM during AVM embolization to better define its utility., Methods: We retrospectively examined AVM embolization cases from 2004 to 2017. We recorded patient and AVM characteristics as well as outcomes. We then reviewed NPM results from each case, including somatosensory evoked potentials and electroencephalogram. Our primary outcome was postoperative neurological deficit, and secondary outcomes were discharge and 30-d modified Rankin Score (mRS)., Results: There were 173 embolizations in 74 patients. Mean patient age was 40 yr. There were 8 (5%) transient and 2 (1.3%) permanent neurological complications. Among those with neurological complications, 3 had NPM changes during the operation (positive predictive value [PPV] = 50%). This improved to 67% for permanent NPM change. Three patients had NPM changes but did not suffer clinical deficits postoperatively (negative predictive value = 90%). The predictive value of the test was improved for discharge but not 30-d mRS, and the test performance improved dramatically with increased pretest probabilities (likelihood ratio [LR](+) = 14.5, LR(-) = 0.715)., Conclusion: We present a large series of AVM embolization operations performed with NPM. The PPV of NPM changes was moderate but improved dramatically with increased pretest probabilities. The rate of permanent neurological complications was among the lowest reported in the literature, suggesting NPM may lead to improved intraoperative decision making., (Copyright © 2019 by the Congress of Neurological Surgeons.)

Background: Posterior fossa syndrome (PFS) is defined as the temporary and complete loss of speech after posterior fossa surgery. The goal of this study was to identify incidence and risk factors for PFS and to determine accompanying neurobehavioral and psychologic problems., Procedure: Between May 2007 and April 2009, children with brain tumors having posterior fossa surgery were evaluated neurologically and psychologically in preoperative and postoperative period., Results: PFS developed in 9 patients among 36 (25%) included in the study. Mutism continued for 120 days in one patient. Histopathological diagnosis (P = 0.05), location of the tumor (P = 0.05) and socioeconomic level of the family (P = 0.06) gave the significant results in relation with the PFS by univariate analyses. In multivariate analysis the risk of developing PFS was found 7.2 times higher in patients with medulloblastoma, 6.7 times higher in tumors located at the midline, 5.7 times higher in families with low socioecnomic level. Intelligence quotients of the patients in PFS and other group (P = 0.85) with Wechsler Intelligence Scale for Children and the results of the Denver II Developmental Screening Test were not significant statistically (P = 0.5)., Conclusion: The diagnosis of medulloblastoma, midline location of the tumor and low socioeconomic level of the families are important risk factors for the development of PFS. These findings support the hypothesis that temporary ischemia and edema due to retracted and manipulated dentate nuclei and superior cerebellar pedincles may be the cause of mutism., (Copyright © 2010 Wiley-Liss, Inc.)

Objective: To study the prevalence and types of substance use disorders (SUDs) in adults diagnosed during childhood as having a developmental language disorder (DLD)., Patients and Methods: The prevalence rates and types of SUDs in a clinical sample of 469 individuals diagnosed during childhood as having a DLD were compared with SUDs in 2,345 matched controls from the general population without a known history of DLD using data from the nationwide Danish Psychiatric Central Register (DPCR). The average observation time was 34.7 years, and the mean age at follow-up was 35.8 years., Results: Of the 469 individuals with DLD, 12 (2.6%) appeared in the DPCR with an SUD diagnosis, compared with 46 (2.0%) in the control group (p = 0.41; OR 1.3; 95% CI 0.7-2.5). Specific SUDs occurred with a low frequency in both groups. Only cocaine-related disorders were significantly associated with DLD (p = 0.03). Variables at assessment in childhood, i.e. gender, IQ, the presence of a receptive language disorder, and the degrees of receptive and expressive language disorders were not associated with an SUD diagnosis in the DPCR at follow-up., Conclusion: Our findings do not support the hypothesis that DLD is a risk factor for SUD in adulthood., (Copyright © 2010 S. Karger AG, Basel.)

Background and Purpose: We aimed to determine if ischemia involving Broca area predicts Broca aphasia more reliably in acute or chronic stroke., Methods: We included consecutive right-hand-dominant patients with left hemisphere ischemic stroke (<48 hours from onset for acute stroke or >6 months after stroke for chronic stroke). MRI scans were analyzed for ischemic lesions or hypoperfusion in Broca area (Brodmann areas 44 and 45). Patients were scored on the Western Aphasia Battery to classify aphasia syndromes; chi(2) tests were used to identify significant associations., Results: The presence of infarct involving any part of Broca area and the presence of Broca or global aphasia was much stronger in acute (chi(2)=38.1; df1; P<0.0001) than in chronic stroke (chi(2)=0.54; df1; P=0.46; not significant). The association between infarct or hypoperfusion covering all of Broca area and the presence of Broca or global aphasia was much stronger in acute (chi(2)=35.8; df1; P<0.0001) than in chronic stroke (chi(2)=1.2; df1; p=0.27; not significant). In a subset of 20 patients studied longitudinally, the associations were significant only acutely, not chronically (chi(2)=20; df1; P<0.0001 vs. chi(2)=0; df1; p=1; not significant for ischemia involving part of Broca area, and chi(2)=16.4; df1; P<0.0001 vs chi(2)=3.2; df1; p=0.08; not significant for ischemia covering all of Broca area)., Conclusions: Broca aphasia is more reliably associated with infarct/ hypoperfusion of Broca area in acute stroke. Many chronic stroke patients with damage to part or all of Broca area had neither Broca nor global aphasia. Broca or global aphasia was sometimes present initially in these patients but resolved by 6 months. Our results indicate that the acute aphasia syndrome may allow the clinician to predict the compromised vascular territory, even when structural imaging shows only a small (or no) infarct.

Background and Purpose: Sleep-disordered breathing (SDB) is more prevalent in stroke patients than age- and sex-matched controls, but the relationship between SDB and functional outcome of stroke patients is unclear. The aim of our study was to determine the prevalence of SDB in ischemic stroke and its influence on functional outcome at 3 and 6 months after stroke onset., Methods: In a prospective study, 60 patients were selected by polysomnography (PSG). The apnea-hypopnea index (AHI) was determined 6.5+/-3.2 days after stroke onset. Neurologic severity at admission was assessed by the Scandinavian Stroke Scale (SSS) and outcome by the Barthel Index (BI). Patients were evaluated on admission, 3 and 6 months after stroke onset., Results: Among the 60 patients, 39 (65%) patients had SDB (AHI5); of these, 30 patients (50%) had AHI15 and 18 (30%)>30. On Logistic regression analysis, the BI at 3 months was independently predicted by SSS (OR=0.74, 95% CI [0.62-0.88], P=0.001) and AHI (OR=1.09, 95% CI [1.02-1.17], P<0.05). At 6 months, the BI was predicted only by SSS (OR=0.83, 95% CI [0.74-0.92], P=0.001)., Conclusions: SDB is common in patients during acute phase after stroke onset. SDB appears to be associated with a worse functional outcome during the early recovery period following stroke, increasing the likelihood of dependency.

Introduction: Aphasias constitute an acquired disorder of the language. Aetiologies are dominated by stroke. The aim of this study was to describe the clinical, epidemiological and evolutionary aspects of the vascular aphasias., Materials and Methods: We conducted from August 2003 to May 2005 a descriptive cross-sectional study at the Neurology department in Dakar. This study concerned all patients admitted at the Neurology department for stroke confirmed by the cerebral tom densitometry. All patients were subjected to an examination of the language allowing to confirm the diagnosis of aphasia and to determine the type. The follow-up was monthly during one year., Results: 55 cases of aphasia were reported on 170 cases of stroke (frequency: 32.35%). Our patients were all right-handed. Mean age was 56.8 (28 to 86 years) with a sex-ratio of 0.61.76.36% of the patients could neither read nor to write. Only two made higher studies. The nature of stroke was ischemic in 73.7% and hemorrhagic in 26.3%. The aphasias with expressive language impairment were observed in 96.4% against 3.6% of the cases for aphasias with comprehensive language impairment. After one year of evolution, a regression of the disorders was observed only in 9 cases, and the regression was partial in 25 cases. The evolution of the aphasia was correlated with that of the motor deficit. Age, low educational level, ischemic stroke constitute factors of bad prognosis., Conclusion: Vascular aphasias are frequent and of reserved prognosis. It disturbs social professional and family reintegration.

The present study investigated the articulatory implementation deficits of Broca's and Wernicke's aphasics and their potential neuroanatomical correlates. Five Broca's aphasics, two Wernicke's aphasics, and four age-matched normal speakers produced consonant-vowel-(consonant) real word tokens consisting of [m, n] followed by [i, e, a, o, u]. Three acoustic measures were analyzed corresponding to different properties of articulatory implementation: murmur duration (a measure of timing), amplitude of the first harmonic at consonantal release (a measure of articulatory coordination), and murmur amplitude over time (a measure of laryngeal control). Results showed that Broca's aphasics displayed impairments in all of these parameters, whereas Wernicke's aphasics only exhibited greater variability in the production of two of the parameters. The lesion extent data showed that damage in either Broca's area or the insula cortex was not predictive of the severity of the speech output impairment. Instead, lesions in the upper and lower motor face areas and the supplementary motor area resulted in the most severe implementation impairments. For the Wernicke's aphasics, the posterior areas (superior marginal gyrus, parietal, and sensory) appear to be involved in the retrieval and encoding of lexical forms for speech production, resulting in increased variability in speech production.

Individuals with agrammatic aphasia may have difficulty with verb production in comparison to nouns. Additionally, they may have greater difficulty producing verbs that have fewer semantic components (i.e., are semantically "light") compared to verbs that have greater semantic weight. A connectionist verb-production model proposed by Gordon and Dell (2003) learns through error correction to "divide the labor" between syntax and semantics. Verbs that are semantically heavier come to depend less on syntax and more on semantics. For lighter verbs, the reverse is true. We performed this study to clarify the role of semantic weight in aphasic verb production and to test the prediction from Gordon and Dell that a brain lesion that impairs the syntactic input to verb retrieval will impair lighter verbs more than heavier ones. Consistent with this prediction, we found that the decrement for lighter verbs was present in a group with agrammatic aphasia but not in a matched group without agrammatism.

This study compared the sentence production abilities of individuals with Broca's and Wernicke's aphasia in an attempt to explore the extent to which impaired lexical retrieval impedes sentence production. The ability to produce active and passive reversible and non-reversible sentences was examined when varying amounts of lexical information was provided. The results showed that both Wernicke's and Broca's aphasic individuals were impaired in passive sentence production and that these difficulties were not overcome when lexical cues (the relevant nouns and uninflected verb) were provided. However when auxiliary and past tense morphemes were provided along with the verb stem, production of passive sentences improved drastically for both groups. Analysis of error patterns, however, revealed differences between the two groups, suggesting that Broca's aphasic subjects may find passive sentences difficult due to problems with retrieving the relevant grammatical morphemes. Subjects with Wernicke's aphasia may have been unable to automatically access the passive sentence structure.

A large portion of the human central nervous system is dedicated to and specialized for language function. Aphasias, disorders of language, can be seen in many psychiatric and neurologic conditions. On occasion, it is difficult to differentiate between language abnormalities secondary to a patient's psychiatric illness and those secondary to a superimposed neurologic condition. In particular, in the evaluation of a patient with a history of a psychotic illness, it is easy to misinterpret the presentation of "abnormal" speech as an exacerbation of the patient's pre-existing psychiatric illness. To show this psychoneurologic comorbidity, two case reports are presented.

The main objective of the present study was to assess the efficiency of the melodic intonation therapy (MIT) in the rehabilitation of Romanian aphasics. Eighty predominantly Broca aphasics used the melodic intonation therapy when no other therapy methods were very efficient. The speech therapist intonated the respective word, then together with the patient and finally let him continue alone. The control group counted 80 aphasics and it applied other therapy methods. Each patient, regardless of the group, was tested twice, before and after therapy. Since most of the patients displayed severe language disorders, and other therapy methods failed in rehabilitating them, MIT was considered an efficient method in the early stages of Broca aphasia with bucco-lingual apraxia.

The relation of sex and age to the incidence and type of aphasia was investigated in 200 aphasic patients. The following conclusions were drawn: (1) Males and females show language disorder with equal frequency. (2) There is a prevalence of non-fluent aphasics in males as compared to females. (3) Broca's aphasics are mildly, but significantly young than Wernicke's aphasics.

The influence of sex, age, educational level and pathologic lesion on incidence, severity and clinical form of aphasia was investigated in 390 right-handed, left brain-damaged patients. Sex and educational level were not related to any parameter. Etiology of lesion and age were related to both incidence and type of aphasia. Incidence of aphasia increased with age and was higher in patients with cerebrovascular accidents than in subjects with other types of brain lesions. Non-fluent forms of aphasia were more frequent in young patients suffering from acute cerebrovascular accidents, whereas anomia prevailed in neoplastic subjects and Wernicke's aphasia increased regularly in frequency with age. Some tentative explanations of these findings are discussed.