Transcranial Magnetic Stimulation and Working Memory Training to Address Language Impairments in Aphasia: A Case Study

Background. Traditionally, people with aphasia (PWA) are treated with impairment-based language therapy to improve receptive and expressive language skills. In addition to language deficits, PWA are often affected by some level of working memory (WM) impairments. Both language and working memory impairments combined have a negative impact on PWA’s quality of life. The aim of this study was to investigate whether the application of intermittent theta-burst stimulation (iTBS) combined with computerized WM training will result in near-ransfer effects (i.e., trained WM) and far-transfer effects (i.e., untrained language tasks) and have a positive effect on the quality of life of PWA. Methods. The participant was a 63-year-old Greek-Cypriot male who presented with mild receptive aphasia and short-term memory difficulties. Treatment was carried out using a multiple baseline (MB) design composed of a pretherapy or baseline testing phase, a therapy phase, and a posttherapy/follow-up phase. The treatment program involved iTBS application to the left dorsolateral prefrontal cortex (DLPFC), an area responsible for WM, for 10 consecutive sessions. The participant received a 3-minute iTBS application followed by 30-minute computer-assisted WM training. Outcome measures included a WM screening test, a standardized aphasia test, a nonverbal intelligence test, story-telling speech samples, a procedural discourse task, and a questionnaire addressing quality of life. These measures were performed three times before the treatment, immediately upon completion of the treatment, and once during follow-up testing at 3 months posttreatment. Results. We found a beneficial effect of iTBS and WM training on naming, reading, WM, reasoning, narrative, communication efficiency, and quality of life (QoL). Implications for Rehabilitation. Noninvasive brain stimulation combined with computerized WM training may be used in aphasia rehabilitation to improve WM and generalize to language improvement.

Intracerebral hemorrhage due to moyamoya syndrome as a rare presentation of cerebral rheumatoid vasculitis: a case report

Background Central nervous system affection in rheumatoid arthritis is rare. The most frequently encountered neurological complications with rheumatoid arthritis are peripheral neuropathy and atlantoaxial subluxation with subsequent spinal cord compression. Cerebral rheumatoid vasculitis is not a common complication. Case presentation A 60-year-old Egyptian female with history of rheumatoid arthritis for 15 years presented with headache and receptive aphasia. Computed tomography scan of the brain showed recent intracerebral hemorrhage. Digital subtraction cerebral angiography showed moyamoya syndrome angiographic pattern as sequelae of intracranial vasculitis. The patient did well with conservative management. Conclusion Cerebral rheumatoid vasculitis is rare, but can be a life-threatening condition. Early management of rheumatoid arthritis is essential to prevent such serious complication.

Recovery patterns and a linguistic therapy model of Sundanese-Indonesian bilingual aphasia: A neurolinguistic study

This study observed a 54-year-old patient with Sundanese-Indonesian bilingual aphasia at the National Brain Center Hospital, Jakarta. He underwent a speech therapy with the treatment given to his second language (Indonesian) during the first two weeks of post-onset and received treatment to his both languages simultaneously for one and a half months post-onset. This research was conducted by using two approaches, namely, a theoretical approach and a methodological approach. In terms of the theory, the approach used in this study is neurolinguistic. In terms of the methodology, the approach is analytic-descriptive with a cohort method. The patient had been diagnosed with having expressive-receptive aphasia in his both languages. Three-time evaluations of his competence in his two languages (during one and a half months post-onset) showed an interesting recovery pattern. In the first evaluation result (two weeks post-onset), it was found that the patient showed a nonparallel recovery; Indonesian (the second language) recovered earlier than Sundanese (the first language). However, in the second evaluation result (a month post-onset), it was found that the improvement in proficiency of the languages showed a parallel recovery; the proficiency improvement of Indonesian after having been given treatment in the therapy showed a recovery parallel to that of Sundanese, even though Sundanese had not been given any treatment at all for a month post-onset. The linguistic track record of this patient showed that Indonesian had a higher level of familiarity compared to Sundanese, and this is correlated with the recovery process of both the languages

Hearing Problems

The most common hearing problems after concussion are hypersensitivity to sound, tinnitus (ringing in the ears), and hearing loss. Excessive sensitivity to sound can be due to migraine, damage to the ear and auditory nerve, or neuropathic pain. Refer to ear, nose, and throat (ENT) specialist for an evaluation of the middle and inner ear. Consider trials of migraine abortive agents (e.g., triptans) and neuropathic pain agents (e.g., pregabalin). For tinnitus, if an audiogram reveals hearing loss, refer to ENT. Treatment from a specialized therapist team including an audiologist and psychologist may improve tinnitus outcomes. Assess for medications that adversely affect the inner ear and reduce them if possible. Test thyroid function. Consider a magnetic resonance imaging (MRI) scan of the brain to make sure that the concussion didn’t unmask another problem, such as a tumor or vascular malformation. A complaint of hearing loss can mean several things: true hearing loss due to middle or inner ear damage, attention deficit, or a language problem such as aphasia. Obtain an audiogram, and if it is abnormal, refer to ENT, assess for attention deficit, and test for receptive aphasia.

Transient Neurologic Deficit without Vascular Pathology Correlates with Reversible Focal Hypoperfusion on Arterial Spin Labeled Perfusion Imaging

We present the case of a 16-year-old boy with altered mental status and magnetic resonance imaging demonstrating left hemispheric hypoperfusion without evidence of stroke, based on arterial spin labeling (ASL) and dynamic contrast-enhanced perfusion imaging. Vessel imaging on magnetic resonance angiography and computed tomography angiography, in addition to an echocardiogram, showed no evidence of an embolic source. Electroencephalography showed left posterior temporal slowing. Within 8 hours, he was awake and alert but with receptive aphasia, and within 24 hours his symptoms completely resolved. Repeat ASL perfusion imaging demonstrated complete resolution of the perfusion abnormality, and diffusion imaging revealed no areas of infarct. This report demonstrates the correlation between a transient neurologic deficit and reversible focal hypoperfusion measured by ASL cerebral perfusion.