Contemporary intraoperative visualization for GBM with use of exoscope, 5-ALA fluorescence-guided surgery and tractography

Maximal safe resection is the primary goal of glioma surgery. By incorporating improved intraoperative visualization with the 3D exoscope combined with 5-ALA fluorescence, in addition to neuronavigation and diffusion tensor imaging (DTI) fiber tracking, the safety of resection of tumors in eloquent brain regions can be maximized. This video highlights some of the various intraoperative adjuncts used in brain tumor surgery for high-grade glioma. In this case, the authors highlight the resection of a left posterior temporal lobe high-grade glioma in a 33-year-old patient, who initially presented with seizures, word-finding difficulty, and right-sided weakness. They demonstrate the multiple surgical adjuncts used both before and during surgical resection, and how multiple adjuncts can be effectively orchestrated to make surgery in eloquent brain areas safer for patients. Patient consent was obtained for publication. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21174

Speech, Language and Cognitive Profile of Mild Cognitive Impairment: A single Case Study

Heterogeneity of symptoms within and among mild cognitive impairment individuals often makes it challenging to document case reports clinically. Additionally, data on the Indian population is also limited. Therefore, our study includes a case study of a 56-year-old male with mild cognitive impairment from our Institute. A patient had symptoms of mild cognitive impairment following a stroke that occurred 23 years back (vascular in origin). Both formal and informal assessments were carried out. Formal testing was done using the Montreal Cognitive Assessment. On assessment of memory, mild deficits in working memory, episodic memory, and procedural memory were noticed. Attention span and Word-finding difficulties with reduced use of words were observed in language assessment. Problems in reasoning, problem-solving, and decision-making skills, indicating deficits in executive functioning were evident. Linguistic deficits presenting secondary to cognitive deficits in our client could have led to communication breakdowns in speech, affecting his overall quality of life.

Reduced Interference and Serial Dependency Effects for Naming in Older but not Younger Adults after 1 Hz rTMS of Right Pars Triangularis

1 Hz rTMS was used to decrease excitability of right pars triangularis (R PTr) to determine whether increased R PTr activity during picture naming in older adults hampers word finding. We hypothesized that decreasing R PTr excitability would reduce interference with word finding, facilitating faster picture naming. 15 older and 16 younger adults received two rTMS sessions. In one, speech onset latencies for picture naming were measured after both sham and active R PTr stimulation. In the other session, sham and active stimulation of a control region, right pars opercularis (R POp), were administered before picture naming. Order of active vs. sham stimulation within session was counterbalanced. Younger adults showed no significant effects of stimulation. In older adults, a trend indicated that participants named pictures more quickly after active than sham R PTr stimulation. However, older adults also showed longer responses during R PTr than R POp sham stimulation. When order of active vs. sham stimulation was modeled, older adults receiving active stimulation first had significantly faster responding after active than sham R PTr stimulation and significantly faster responding after R PTr than R POp stimulation, consistent with experimental hypotheses. However, older adults receiving sham stimulation first showed no significant differences between conditions. Findings are best understood, based on previous studies, when the interaction between the excitatory effects of picture naming and the inhibitory effects of 1 Hz rTMS on R PTr is considered. Implications regarding right frontal activity in older adults and for design of future experiments are discussed.

Central nervous system involvement of anaplasmosis

A 64-year-old woman presented with 24 hours of lethargy, confusion, headache, nausea and vomiting. Examination revealed expressive aphasia, conjunctival suffusion and a tick embedded in her popliteal fossa. Labs revealed hyponatraemia, transaminitis, leucopenia, thrombocytopenia and an elevated C reactive protein. Peripheral blood smear was unremarkable. MRI/magnetic resonance angiogram revealed bilateral frontoparietal subarachnoid haemorrhage which was further confirmed by lumbar puncture which revealed six nucleated cells, 92% lymphocytes, 1460 red blood cells, normal glucose and protein and negative cryptococcal antigen, herpes simplex PCR and Lyme PCR. Serum Lyme IgG/IgM antibodies and PCR, Erlichia chaffeensis serum IgG/IgM antibodies and PCR and anaplasma serum IgG/IgM antibodies were negative. Anaplasmosis serum PCR was positive. The tick was identified as Ixodes scapularis. The patient was diagnosed with anaplasmosis and treated with 21 days of doxycycline resulting in improvement of symptoms, but lingering headaches and word finding difficulties.

Right-hemisphere compensation during word production: A single case of left-hemisphere young stroke

Our understanding of post-stroke language recovery and underlying neuroplasticity is largely based on older age groups, who have increasing brain pathology and potentially more bilateral language functioning. We present the case of A., a 23 y.o. woman with chronic aphasia from a left-hemisphere stroke. Deterministic tractography indicated that A.’s language-relevant white matter structures were severely damaged. Using magnetoencephalography (MEG), we explored A.’s conceptual preparation and subsequent word planning abilities. Context-driven and Bare picture-naming tasks revealed substantial naming deficits, manifesting as word-finding difficulties and semantic paraphasias about half of the time. Naming was however facilitated by semantically constraining lead-in sentences. Altogether, this pattern indicates intact conceptual preparation but disrupted lexical and phonological retrieval abilities. MEG revealed that A.’s naming-related neural responses differed from that of a matched control. Source localisation showed active but differential recruitment of right-hemisphere structures (300-400 ms post-picture onset) during both correct naming (right temporo-parietal regions) and anomic (right inferior frontal gyrus) attempts. We consider that, despite A.’s young age, the presumed strong degree of language lateralisation and extensive structural damage limited her recovery. Although A.’s right hemisphere responded in a timely manner during word planning, its lexical and phonological retrieval abilities remained modest.

Differential Associations of White Matter Brain Age With Language-Related Mechanisms in Word-Finding Ability Across the Adult Lifespan

Research on cognitive aging has established that word-finding ability declines progressively in late adulthood, whereas semantic mechanism in the language system is relatively stable. The aim of the present study was to investigate the associations of word-finding ability and language-related components with brain aging status, which was quantified by using the brain age paradigm. A total of 616 healthy participants aged 18–88 years from the Cambridge Centre for Ageing and Neuroscience databank were recruited. The picture-naming task was used to test the participants’ language-related word retrieval ability through word-finding and word-generation processes. The naming response time (RT) and accuracy were measured under a baseline condition and two priming conditions, namely phonological and semantic priming. To estimate brain age, we established a brain age prediction model based on white matter (WM) features and estimated the modality-specific predicted age difference (PAD). Mass partial correlation analyses were performed to test the associations of WM-PAD with the cognitive performance measures under the baseline and two priming conditions. We observed that the domain-specific language WM-PAD and domain-general WM-PAD were significantly correlated with general word-finding ability. The phonological mechanism, not the semantic mechanism, in word-finding ability was significantly correlated with the domain-specific WM-PAD. In contrast, all behavioral measures of the conditions in the picture priming task were significantly associated with chronological age. The results suggest that chronological aging and WM aging have differential effects on language-related word retrieval functions, and support that cognitive alterations in word-finding functions involve not only the domain-specific processing within the frontotemporal language network but also the domain-general processing of executive functions in the fronto-parieto-occipital (or multi-demand) network. The findings further indicate that the phonological aspect of word retrieval ability declines as cerebral WM ages, whereas the semantic aspect is relatively resilient or unrelated to WM aging.

An exploration of lexical selection in adults who stutter

BACKGROUND AND OBJECTIVE: People who stutter (PWS) are able to anticipate a moment of stuttering. We wished to explore whether this anticipation might be reflected by either unusual word choice and/or delayed word production during a single-word confrontation naming task. METHOD: Nine PWS and nine age- and sex-matched fluent controls completed the single-word confrontation-naming task. Groups were compared on numbers of word-finding and fluency errors, response latency, and naming accuracy, measured against a novel ‘usuality’ criterion. Regression modelling of response accuracy and latency was conducted. RESULTS: The groups did not differ on naming task performance, except for a greater frequency of response latency errors in the PWS group. For both groups, responses containing word-finding or fluency errors were more likely to be non-usual names, and these were associated with longer latencies than accurate responses. For PWS, latency was positively related to participant age, and accuracy inversely related to stuttering severity. CONCLUSIONS: The findings provide insights into word substitution as a generalized behaviour, its function, and associated time-cost. Group-specific relationships imply greater sensitivity in PWS to changing demands and capacities, and highlight the complexity of interactions between physical stuttering behaviour and verbal avoidance.

The Subjective Experience of Word-Finding Difficulties in People With Aphasia: A Thematic Analysis of Interview Data

Purpose Anomia, or difficulty with naming and word finding, is a pervasive deficit among individuals with aphasia. There is an extensive literature on the mechanisms underlying anomia and on approaches to treatment, but very little is known about the subjective experience of anomia during day-to-day life. Method As part of a larger testing battery, 53 adults with poststroke aphasia took part in a novel, structured interview that included an open-ended question about the general experience of anomia: “Do you ever know what you want to say, but you can't say it out loud? Please describe that feeling.” Video-recorded interview responses were transcribed and analyzed using thematic analysis, an iterative, data-driven process that categorizes interview data into common themes. Results Five main themes emerged among the data from 37 participants who produced adequate responses for use in thematic analysis: strategies to cope with or compensate for anomia, comments on awareness of the level of breakdown (e.g., “I have an idea, but can't get the right words”), negative emotions, impact on relationships, and changes in frequency over time. Conclusions Participants showed strong awareness of anomia and its implications, demonstrating an ability to describe their language breakdown, identify relevant strategies to compensate and/or cope, and acknowledge the impact of anomia on their emotions and social interactions. This patient perspective may serve as a valuable supplement to information typically gained via objective language assessments. Clinicians and researchers may wish to consider incorporating similar subjective measures during assessment and treatment planning. Supplemental Material https://doi.org/10.23641/asha.15032643

Self-reported word-finding complaints are associated with cerebrospinal fluid beta-amyloid and atrophy in cognitively normal older adults

Background and Objectives: Self-reported language complaints, and more specifically word-finding difficulties, are among the most frequent cognitive complaints in cognitively normal older adults (CN). The clinical significance of elevated self-reported word-finding complaints in CN is still a matter of debate. The present study aims at characterizing word-finding complaints in CN, establish their sociodemographic and psychological correlates, determine if they are predictive of lower levels of cerebrospinal fluid Aβ levels and finally, investigate if they are associated with brain atrophy in regions associated with naming impairments. Methods: In this observational case-control study, 239 CN from the Alzheimer Disease Neuroimaging Initiative (ADNI) database were selected. All participants completed the self-reported version of the Everyday Cognition (ECog) questionnaire, as well as a lumbar puncture for Aβ and a MRI. Results: Word-finding complaints were rated equally severe as a few other memory items and significantly more severe compared to all the other cognitive complaints. Ecog-Lang1 (Forgetting the names of objects) was not related to any demographic (age, sex, years of education) or psychological variable (depression-related symptoms, anxiety-related symptoms), while Ecog-Lang3 (Finding the right words to use in a conversation) was significantly negatively associated with years of education and positively associated with depression-related symptoms. Ecog-Lang1 severity significantly predicted CSF Aβ levels in CN, and this result remained significant even when controlling for all demographic and psychological variables as well as general level of cognitive complaint. Individuals with high Ecog-Lang1 complaints showed atrophy in the left fusiform gyrus and the left rolandic operculum in comparison to CN with no or low Ecog-Lang1 complaints. Discussion: Overall, our results support the fact that word-finding complaints are significant in CN and should be taken seriously. They have the potential to identify CN at risk of AD and support the need to include other cognitive domains in the investigation of subjective cognitive decline.

Supratentorial lymphocytic inflammation with parenchymal perivascular enhancement responsive to steroids: A case report and literature review

Background: Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids is a rare disorder that presents with subacute brainstem symptoms such as ataxia, facial paresthesias, and episodic diplopia, thought to be due to a T-cell medicated perivascular inflammatory process. A supratentorial variant, Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids (SLIPPERS), has been described in only three patients. Case Description: A 71-year-old male presented with word-finding difficulties, confusion, and left leg weakness. Radiographic workup demonstrated multiple supratentorial ring-enhancing lesions. PET/CT demonstrated hypermetabolism and susceptibility-weighted imaging demonstrated a hemorrhagic component. Frozen pathology revealed a predominately T-cell and monocyte inflammatory infiltrate. He demonstrated interval improvement to dexamethasone therapy, but then demonstrated worsening of his symptoms following discontinuation. Conclusion: Given his dramatic response to corticosteroids, he was diagnosed with SLIPPERS. SLIPPERS is an underrecognized diagnostic entity to consider in patients with ring-enhancing lesions and can present with hypermetabolic lesions on PET/CT.