Effects of mirror therapy on motor aphasia after acute cerebral infarction: A randomized controlled trial

BACKGROUND: Mirror therapy (MT) has proven to be beneficial for treating patients suffering from motor aphasia after stroke. However, the impacts of MT on neuroplasticity remain unexplored. OBJECTIVE: In this paper we conducted a randomized controlled trial to evaluate the treatment using the MT on motor aphasia following acute cerebral infarction. METHODS: We randomly assigned 30 patients into test and control groups, with test group patients treated with MT, whereas control group patients were treated with sham MT. At 24 hours prior to and after the intervention, we obtained functional magnetic resonance imaging (fMRI) data from study subjects. At baseline, after treatment and 12-week follow-up, we additionally evaluated patients with the Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the aphasia quotient (AQ) in the western aphasia test. RESULTS: After 2 weeks of treatment, the test group demonstrated significant improvements in AQ values, naming, repetition, spontaneous speech, and mRS scores compared to the control group (P < 0.05). Furthermore, in the follow-up time point (12 weeks), we found that the test group exhibited significantly better NIHSS scores and AQ evaluation indicators than the control group (P < 0.05). Specifically, the fMRI study shows that functional connectivity significantly improved in test group patients mainly among frontal, temporal, and parietal lobes of the left hemisphere with each other than controls group. Meanwhile, we found significantly enhanced functional connectivity with the hippocampus (P < 0.01). CONCLUSIONS: Our results indicate that the MT can expedite the recovery of language function during the early phases of stroke recovery. These findings may elucidate the underlying mechanism of MT and the application of this therapy as an adjunct rehabilitation technique in language recovery.

An “over-fused middle cerebral artery” anomaly: a case report

Background MCA has several anomalies, such as accessory MCA, duplicated MCA and twig-like MCA, up to now all these reported anomalies were hypothesized to due to the failure in fusion of the primitive arterial network. No anomaly of over fused MCA has been reported. Case presentation A 59- year- old male was hospitalized with a history of paroxysmal slurred speech and left side headache for a week, his blood pressure was 160/80 mmHg and he manifested mild incomplete motor aphasia at the time of admission. The head and neck CTA and DSA all presented a huge and tortuous left MCA, we diagnosed it an anomaly and termed it over-fused MCA. The patient’s speech impairment and headache were relieved by controlling his blood pressure. Conclusions Such an anomaly of over-fused MCA is reported for the first time, it’s not needed to put special intervention on the anomaly of the patient temporarily, but more observation are needed.

Acute ischemic stroke in young adult: Atrial fibrillation, hyperthyroidism, and COVID-19 collaboration

Atrial fibrillation is a frequently detected cardiac arrhythmia in the etiology of ischemic stroke. The incidence of atrial fibrillation and the risk of it causing ischemic stroke increase significantly with age; it is rare in young people. It is known that the risk of developing atrial fibrillation is high when there is a background of hyperthyroidism. COVID-19 is thought to cause thromboembolic events, cardiac pathologies, and endocrine disorders. A 54-year-old presented with right-sided hemiplegia and motor aphasia of 1.5 h duration. On evaluation, he tested positive for SARS-CoV-2 imaging was suggestive of acute pons ischemia and found to have hyperthyroidism and atrial fibrillation. It is clear that atrial fibrillation, which is highly unlikely to cause ischemic stroke in young adults, may develop due to hyperthyroidism. COVID-19 has been suggested as a cause of atrial fibrillation and hyperthyroidism. It is also thought to be involved in the etiology of stroke by causing hypercoagulation or triggering vasoconstriction through the renin–angiotensin system.

KEJADIAN AFASIA PADA STROKE FASE AKUT DAN PERUBAHAN SINDROM AFASIA PASCASTROKE

THE OCCURRENCE AND EVOLUTION OF APHASIA SYNDROME WITHIN ONE MONTH AFTER STROKEABSTRACTIntroduction: Aphasia is a barrier for the rehabilitation of patients with stroke. The examination of aphasia is not only for diagnostic purpose, but also for the patient remaining language proficiency information and for comprehensive stroke treatment.Aims: To study the incidence rate of aphasia in acute ischemic stroke and the change of the aphasia syndrome one month after stroke.Methods: A descriptive observational with cohort study on ischemic stroke patients in Neurology ward, Dr. Hasan Sadikin Hospital and other hospitals in Bandung between November 2017 and February 2018. Tes Afasia, Diagnosis, Informasi dan Rehabilitasi(TADIR, a tools for diagnostic and rehabilitation of aphasia for Indonesian) was used to diagnose aphasia initially and repeated one month after diagnosis.Results: Aphasia was found in 24 out of 102 patients with acute ischemic stroke (23.5%). Majority was male (58.3%), the average age of the patients was 55.6±11,4 years and 8.8 years of education. The most common type of stroke causing aphasia was cardioembolic (62.5%). Based on the types, the most aphasia syndrome found in this study were global aphasia (58.3%), followed by Broca aphasia (25%). Twenty patients with aphasia were re-examined after one month and 40% patients experienced transformation into other type of aphasia syndrome. Between patients with global aphasia, 45.5% transformed into Broca aphasia and 9% into transcortical motor aphasia. Patients with Broca aphasia did not experience transformation, 50.0% of Wernicke aphasia transformed into conductive aphasia, and one conductive aphasia patient transformed into anomic aphasia.Discussion: The occurrence of aphasia in acute ischemic stroke is 23.5%. Within one month after stroke, 40% patients with aphasia have shown transformation from one type into other type of aphasia syndrome.Keyword: Aphasia, language proficiency, stroke, TADIRABSTRAKPendahuluan: Afasia dapat menghambat rehabilitasi pasien stroke. Pemeriksaan afasia, tidak hanya untuk keperluan diagnosis, namun juga sebagai informasi kemampuan berbahasa pasien yang tersisa dan akan bermanfaat untuk tata laksana stroke yang komprehensif.Tujuan: Mengetahui kejadian afasia pada stroke iskemik fase akut dan perubahannya pada satu bulan kemudian.Metode: Penelitian deskriptif observasional dengan rancangan kohort terhadap pasien stroke iskemik yang dirawat di ruang rawat inap Neurologi RSUP Dr. Hasan Sadikin dan beberapa RS di Bandung dan sekitarnya pada bulan November 2017 sampai Februari 2018. Penilaian afasia menggunakan Tes Afasia, Diagnosis, Informasi, dan Rehabilitasi (TADIR) yang diulang pada satu bulan kemudian.Hasil: Afasia ditemukan pada 24 dari 102 pasien stroke iskemik fase akut (23,5%). Mayoritas subjek adalah laki-laki (58,3%) dengan rerata usia 55,6±11,4 tahun dan rerata lama pendidikan 8,8 tahun. Penyebab afasia terbanyak adalah stroke kardioemboli (62,5%). Sindrom afasia yang terbanyak ditemukan adalah afasia global (58,3%) diikuti afasia Broca (25%). Pemeriksaan ulang pada satu bulan pascastroke dilakukan terhadap 20 pasien afasia, dan didapatkan 40% mengalami perubahan sindrom. Sebanyak 45,5% pasien afasia global berubah sindrom menjadi afasia Broca dan 9,0% menjadi afasia transkortikal motorik. Afasia Broca tidak mengalami perubahan sindrom. Seorang pasien dengan sindrom afasia Wernike berubah menjadi afasia konduksi; dan satu pasien dengan sindrom afasia konduksi berubah menjadi afasia anomik.Diskusi: Kejadian afasia pada stroke iskemik fase akut adalah 23,5%. Satu bulan pascastroke, 40% pasien afasia mengalami perubahan sindrom.Kata kunci: Afasia, kemampuan berbahasa, stroke, TADIR