Language studies were done on four multilingual dextral Chinese patients who developed dysphasia from various causes. The left hemisphere appeared to be dominant for all the languages in the four patients. All the languages and dialects were universally involved during the development of dysphasia. In one patient,
there was evidence of delayed restitution in the patient's mother tongue (Hokkien) comparing with Mandarin and English which were the languages used in the hospital and for reading.
Dysphagia is a common symptom in patients presenting to the otorhinolaryngolgy clinic. However, vascular causes (dysphasia lusoria) are relatively rare. W report a case of dysphagia caused by a saccular aneurysm of the descending thoraric aorta. The outline of management is discussed.
The present study deals with observations on the "speech evoked potential"-a late positive potential evoked by word repetition. These potentials, evoked by "silent" repetition of polysyllabic words, were averaged and recorded from the scalp overlying the inferior frontal regions on both sides in 20 normal healthy subjects of ages ranging from 13-58 years. The potential had a triphasic negative, positive, negative morphology and was present over both hemispheres in left as well as right handed subjects. The main positive deflection and mean latencies of 219.2 msec and 221.6 msec and mean amplitude of 6.2 muv and 6.5 muv respectively on the left and right sides. Though there were interindividual variations in latency, amplitude and morphology, there was a high degree of intraindividual similarity and reproducibility in subjects. The variations in these parameters with age, sex and handedness are discussed. In 10 patients with cerebral lesions, the evoked potential was normal in 5 cases with right frontal lesions and showed abnormalities in 3 of 5 cases with left frontal lesions. The speech evoked potential may be useful in the further study of electrical correlates of speech output in speech disorders.
Concomitant recent myocardial infarction (MI) in patients presenting with acute ischaemic stroke (AIS) is considered a relative contraindication for thrombolysis. Mechanical thrombectomy is recognised as an alternative recanalisation therapy to avoid risk of haemorrrhagic complications. We report a 77-year-old patient who previously had recent admission for late presentation ST elevation myocardial infarction (STEMI) and currently presented with right-sided hemiplegia, dysphasia and reduced level of consciousness at 30 minutes from the onset. An urgent cerebral angiography showed total occlusion of the left middle cerebral artery (MCA). Successful mechanical thrombectomy was performed instead of administration of intravenous (IV) thrombolysis with excellent neurological recovery. This case report highlights the importance of patient transfer to a more comprehensive stroke center in the management strategies of the AIS.
Objective: Pathological laughter, pseudobulbar affect or a myriad of its other synonyms, is a condition common secondary to neurological injury, presenting with uncontrolled laughing or crying, appearing to be mood-incongruent and significantly debilitating. The objective of this case report is to highlight a rare case of pathological laughter associated with Cerebral Lupus.
Methods: We report a case of a 27-year-old lady presenting with signs and symptoms of stroke with dysarthria progressing to aphasia and then pathological laughter, with an underlying poorly controlled Systemic Lupus Erythematosus, manifesting as Cerebral Lupus.
Results: An improvement in affect congruency followed by decreased frequency of outbreaks among bouts of pathological laughter.
Conclusion: The combination of Escitalopram and Topiramate is effective in the symptomatic treatment of Pathological Laughter.
It has been suggested that formal thought disorder, the incoherent speech of schizophrenia, may involve a language disturbance among other abnormalities, or even be a form of dysphasia. Six patients with and seven without formal thought disorder were evaluated on an aphasia test battery. Spontaneous speech was also analysed using Brief Syntactic Analysis. Poor performance on the aphasia test battery was found to be associated with general intellectual impairment but not with formal thought disorder. Naming was preserved in both groups. Patients with formal thought disorder, but not those without, produced semantic errors in their spontaneous speech, and these were unrelated to general intellectual status. The disorder of language in formal thought disorder thus appears to be one of expressive semantic abnormality, which, however, spares naming. Further analysis of two intellectually preserved patients suggested that formal thought disorder may be associated with an additional difficulty in constructing an appropriate model for generating one's own speech.
There are four classification levels for speech disorders namely dysphonia, dysarthria, dysprosody and dysphasia. In general, speech examination mainly focuses on three main components that are spontaneous speech, auditory comprehension, and oral motor examination. Quick bedside assessment on speech in Bahasa Malaysia is essential to assist the speech language therapist (SLT) and other physicians to determine the disorders. Speech therapy is also essential in monitoring and continuous assessment for patients with speech and language disorders such as dysphasia and dysarthria. Speech clinicians in Hospital Universiti Sains Malaysia (HUSM) have been adapting two most widely used batteries of speech assessment tools namely Western aphasia battery-revised (WAB-R) by Andrew Kertesz and Boston diagnostic aphasia examination (BDAE). These tools have been modified into simple and validated speech assessments in Bahasa Malaysia. This video manuscript will demonstrate the use of both tools in performing bedside speech assessment for patients with speech disorders. The Bahasa Malaysia speech examination should not be difficult when WAB-R and BDAE speech assessment tools are applied. The aim of this simple approach using the adapted version of BDAE and WAB-R is to assist the clinician to achieve quick and accurate diagnosis with a validated scoring system.
Cerebral Venous Thrombosis in patients with Evan’s Syndrome of autoimmune hemolytic anemia is rare. The
common neurological symptoms are headaches, vision loss, dyslexia without agraphia, motor aphasia,
unilateral upper limb weakness and papilloedema. We present a case report of a lady with a known case of
Evan’s Syndrome whom presented with severe anemia and unilateral right sided hemiparesis with right facial
weakness. Plain and Contrast enhanced CT brain showed bilateral high parietal white matter edema with
venous thrombosis in the right transverse and superior sagittal venous sinuses. At the time of the diagnosis,
she was in hematological remission.
Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but normotensive. However, two fast boluses totalling 40 ml/kg normal saline were given. She was transferred to another hospital where she was intubated due to drowsiness. Rehydration fluid (maintenance and 48-hour correction for 7.5% dehydration) was started followed by insulin infusion. She was extubated within 24 hours of admission. Her ketosis resolved soon after and subcutaneous insulin was started. However, about 48 hours after admission, her Glasgow Coma Scale score dropped to 11/15 (E4M5V2) with expressive aphasia and upper motor neuron signs. One dose of mannitol was given. Her symptoms improved gradually and at 26-month follow-up she had a near-complete recovery with only minimal left lower limb weakness. Serial magnetic resonance imaging brain scans showed vascular ischaemic injury at the frontal-parietal watershed regions with haemorrhagic transformation. This case reiterates the importance of monitoring the neurological status of patient's with DKA closely for possible neurological complications including an ischaemic and haemorrhagic stroke.