Biomedical subjects
Publications and source records attributed to G M Seliger.
BACKGROUND: We describe a patient who presented a unique variation of the previously described acquired foreign accent syndrome. CASE DESCRIPTION: A 65-year-old women developed an Irish brogue immediately after a deep left hemisphere stroke. The newly accented speech possibly represented a previously learned speech pattern. CONCLUSIONS: Suppressed prosodic speech patterns may reemerge in the setting of brain injury.
Respiratory failure in syringomyelia has rarely been reported. We report a patient with syringomyelia who showed some neurological improvement after intermittent respiratory support with negative and positive pressure ventilation.
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Traumatic basal ganglia hemorrhage (TBGH) is probably secondary to rupture of lenticulostriate or anterior choroidal arteries. We evaluated 6 consecutive cases of this entity to define its clinical and pathologic dimensions. Relative frequency of TBGH was 3% (3 left, 3 right) in this acute rehabilitation population. Lesion size and associated pathology varied. Contralateral hemiparesis, present in all, recovered to varying extents, apparently related to lesion location (posterior limb, internal capsule, or midperiventricular white matter), not size. Prolonged muteness occurred in 4 of 6; these 4 patients also had severe diffuse axonal injury. Clinical findings corresponded with previously recognized subcortical hemisphere profiles. All achieved a moderate disability or good recovery rating on the Glasgow Outcome Scale. Rather than any features of the TBGH itself, duration of coma and/or associated temporal herniation predicted slower recovery and worse outcome. In conclusion, TBGH is a rare entity compatible with a favorable recovery, especially when occurring in isolation. The hemorrhage itself determines clinical signs related to particular subcortical structures involved and the side of the lesion. Overall cognitive impairment and speed and quality of recovery are more related to associated cerebral damage.
Pure word deafness, usually involving left hemisphere focal lesions that destroy Heschl's gyrus and/or isolate auditory association cortex, may be rare, but cases with additional perceptual or cognitive symptoms may not be. Word deafness can be transient or evolving, and has been seen in various conditions without identifiable focal lesions. Only two closed head injury cases with focal contusions have been reported; we report two more, with diffuse damage and no focal signs. One patient's symptoms evolved soon after they were recognized. The other patient's unresponsiveness to spoken verbal stimuli persisted despite relatively preserved reading and speech, in a context of poor initiation and moderately severe cognitive impairment. Unrecognized, word deafness following head injury could lead to overestimation of coma duration if transient, and impede rehabilitation if chronic.
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Emotional incontinence is a behavioural syndrome characterized by involuntary weeping, grimacing, and/or laughter. We investigated the efficacy of fluoxetine in 13 patients with emotional incontinence. All 13 patients demonstrated dramatic improvement in emotional lability within 3 to 14 days.