Síndrome de Balint y trombosis de senos venosos cerebrales: reporte de caso / Balint syndrome and cerebral venous sinus thrombosis: Case report

Introducción: El síndrome de Balint es un trastorno neurológico infrecuente, de etiología diversa, cuya presentación incluye la triada clásica de: simultagnosia, ataxia óptica y apraxia oculomotora, síntomas secundarios asociados a lesiones parieto-occipitales, con pronóstico variable según la etiología que se encuentre. A continuación, se reporta un caso secundario a una trombosis de senos venosos. Presentación del caso: Mujer de 66 años que ingresa a urgencias por cefalea aguda asociada a síntomas neurológicos progresivos con compromiso visual. Presentó tensión arterial elevada, simultagnosia, ataxia óptica y apraxia oculomotora. Los estudios imagenológicos reportaron hemorragia subaracnoidea por trombosis de seno sigmoideo izquierdo, por lo que se inició anticoagulación, antihipertensivo, con adecuada evolución del cuadro clínico. Discusión: A pesar de que el síndrome de Balint es un trastorno poco común, de etiología diversa, con escasos reportes a escala global, el caso comentado concordó con las características descritas en la literatura. El abordaje de la paciente en su atención inicial permitió la sospecha diagnóstica oportuna y la indicación de ayudas diagnósticas imagenológicas pertinentes. Tales ayudas soportaron un manejo temprano y la adecuada evolución y resolución del cuadro, en el contexto de la asociación del síndrome a una trombosis de senos venosos cerebrales (una etiología infrecuente). Conclusión: Mediante una historia clínica completa y minuciosa, junto a un adecuado examen neurológico, es posible hacer un acercamiento diagnóstico temprano que permita generar la sospecha del síndrome de Balint y la solicitud temprana de imágenes diagnósticas que orienten en el estudio de su etiología y manejo oportuno, con mejores desenlaces en el paciente.

Introduction: Balint Syndrome is a rare neurological disorder with multiple etiologies. The physical signs include a classic triad (simultagnosia, optic ataxia, and oculomotor apraxia). These symptoms are associated with parieto-occipital lesions, and the prognosis depends on the etiology. This article reports a case secondary to venous sinus thrombosis. Presentation of the case: A 66-year-old woman presented to the emergency room with acute headache associated with progressive neurological symptoms and visual impairment. She had high blood pressure, simultanagnosia, optic ataxia, and oculomotor apraxia. Imaging studies revealed subarachnoid hemorrhage due to thrombosis of the left sigmoid sinus, for which anticoagulation and antihypertensive therapy were started. The patient had a favorable clinical outcome. Discussion: Although Balint syndrome is a rare disorder of diverse etiology with few clinical cases reported globally, the case discussed here was consistent with the characteristics described in the literature. The patient's initial assessment allowed for timely diagnostic suspicion and appropriate imaging studies, which supported early management and the appropriate evolution and resolution of the condition, given the association of the syndrome with an uncommon cause as cerebral venous sinus thrombosis. Conclusion: A complete and thorough medical history, along with a proper neurological exam, can lead to an early diagnostic approach that raises suspicion of Balint's syndrome and prompts timely imaging studies to guide the investigation of its etiology and management, ultimately leading to better outcomes for the patient.

Síndrome de Anton-Babinsky / Anton-Babinski Syndrome

Introducción: El síndrome de Anton-Babinsky es un trastorno neuropsiquiátrico poco frecuente, que se manifiesta por anosognosia y ceguera cortical, debido a lesiones en las áreas visuales asociativas de la corteza occipital sin presentar afectación en la vía visual. En adultos mayores sus manifestaciones clínicas suelen ser atípicas y la valoración geriátrica integral permite orientar el diagnóstico, que se puede asociar con síndromes geriátricos. Objetivo: Describir las manifestaciones clínicas, síndromes geriátricos, paraclínicos y tratamiento de un paciente con Síndrome de Anton-Babinsky. Caso clínico: Paciente de 85 años, quien durante un postoperatorio inmediato de cirugía ocular (pterigión) presentó alteración fluctuante del estado de conciencia, alucinaciones visuales, disminución de la agudeza visual bilateral y anosognosia. La analítica sanguínea no reportó alteraciones y la tomografía computarizada de cráneo documentó isquemia occipital bilateral, se le diagnosticó síndrome de Anton-Babinsky. Conclusiones: El síndrome de Anton-Babinsky puede tener presentación atípica a través de síndromes geriátricos. La valoración geriátrica integral permite realizar un diagnóstico y manejo multicomponente oportuno con el objetivo de influir en el pronóstico tanto a corto como a largo plazo(AU)

Introduction: Anton-Babinski syndrome is a rare neuropsychiatric disorder, with a manifestation of anosognosia and cortical blindness, due to lesions in the associative visual areas of the occipital cortex without presenting visual pathway impairment. In elderly adults, its clinical manifestations are usually atypical and a comprehensive geriatric assessment allows to guide the diagnosis, which can be associated with geriatric syndromes. Objective: To describe the clinical manifestations, geriatric syndromes, paraclinical findings and treatment of a patient with Anton-Babinski syndrome. Clinical case: This is the case of an 85-year-old patient who, during the immediate postoperative period after ocular surgery (pterygium), presented a fluctuating alteration of consciousness, visual hallucinations, decreased bilateral visual acuity and anosognosia. Blood analysis reported no alterations and cranial computed tomography documented bilateral occipital ischemia; the patient was diagnosed with Anton-Babinski syndrome. Conclusions: Anton-Babinski syndrome may have an atypical presentation through geriatric syndromes. Comprehensive geriatric assessment allows for timely multicomponent diagnosis and management with the aim of influencing both short- and long-term prognosis(AU)

Anosognosia in dementia with Lewy bodies: a systematic review / Anosognosia na demência com corpos de Lewy: uma revisão sistemática

ABSTRACT Background: Anosognosia, i.e. lack of awareness of one's own symptoms, is a very common finding in patients with dementia and is related to neuropsychiatric symptoms and worse prognosis. Although dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia, literature on anosognosia in this disease is scarce. Objectives: This paper aimed to review the current evidence on anosognosia in patients with DLB, including its prevalence in comparison with other neurological conditions, its severity and anatomical correlations. Methods: Database searches were performed in PubMed, Web of Knowledge and PsycINFO for articles assessing anosognosia in DLB. A total of 243 studies were retrieved, but only six were included in the review. Results: Potential risk of selection, comparison or outcome biases were detected in relation to all the studies selected. Most of the studies used self-report memory questionnaires to assess cognitive complaints and compared their results to scores from informant-based instruments or to participants' cognitive performance in neuropsychological tasks. Subjects with DLB had worse awareness regarding memory than healthy older controls, but the results concerning differences in anosognosia between DLB and Alzheimer's disease (AD) patients were inconsistent across studies. Presence of AD pathology and neuroimaging biomarkers appeared to increase the prevalence of anosognosia in individuals with DLB. Conclusion: Anosognosia is a common manifestation of DLB, but it is not clear how its prevalence and severity compare with AD. Co-existence of AD pathology seems to play a role in memory deficit awareness in DLB.

RESUMO Introdução: Anosognosia, i.e. a perda da consciência dos próprios sintomas, é um achado muito comum em pacientes com demência e está relacionada a sintomas neuropsiquiátricos e a pior prognóstico. Embora a doença por Corpos de Lewy (DCL) seja a segunda demência degenerativa mais comum, há pouca evidência sobre anosognosia nessa doença. Objetivos: Este artigo teve como objetivo revisar a evidência disponível sobre anosognosia em pacientes com DCL, incluindo sua prevalência em comparação a outras condições neurológicas, gravidade e correlações anatômicas. Métodos: Foram feitas buscas nos bancos de dados PubMed, Web of Knowledge e PsycINFO por artigos que avaliassem anosognosia na DCL. Um total de 243 estudos foi encontrado, mas apenas 6 foram incluídos nesta revisão. Resultados: Potenciais riscos de viés de seleção, comparação ou resultado foram encontrados em todos os estudos selecionados. A maior parte dos estudos utilizou questionários de memória preenchidos pelo próprio paciente e os comparou a resultados de instrumentos preenchidos por informantes ou à performance cognitiva em tarefas neuropsicológicas. Indivíduos com DCL têm pior consciencia de memória do que idosos saudáveis, mas os resultados tocantes à diferença de anosognosia entre DCL e doença de Alzheimer (DA) são inconsistentes entre estudos. A presença de achados patológicos e de neuroimagem de DA parece aumentar a prevalência de anosognosia entre pacientes com DCL. Conclusão: Anosognosia é uma manifestação comum da DCL, mas não é possível afirmar como sua prevalência e gravidade se comparam à DA. A coexistência de achados patológicos de DA parece influenciar a consciência de déficits de memória na DCL.

Análisis neuropsicológico de un caso con anosognosia / Neuropsychological analysis of a case with anosognosia

Resumen La anosognosia es un trastorno neuropsicológico que genera en el paciente una incapacidad para tener un estado de conciencia pleno sobre su enfermedad o déficit, producto de una injuria cerebral. En este artículo reportamos el análisis de un caso que producto de un traumatismo craneoencefálico presentó esta alteración cerebral. El análisis neuropsicológico inicia con la descripción clínica del caso, su estado premórbido, el relato familiar del estado actual y un análisis neuropsicológico que sustenta la hipótesis diagnóstica de anosognosia. Se discute el caso presentado en base a la necesidad de realizar diagnósticos precisos y proponer programas de rehabilitación neuropsicológica para que los pacientes con anosognosia sufran el menor impacto posible en las actividades de su vida diaria producto del trastorno cerebral adquirido.

Anosognosia is a neuropsychological disorder that generates in the patient an inability to have a state of full awareness about their disease or deficit due to brain injury. In this article we report the analysis of a case that, due to a head injury, presented this brain disorder. The neuropsychological analysis begins with the clinical description of the case, its premorbid status, the family report of the current state and a neuropsychological analysis of the symptoms presented that support the diagnostic hypothesis of anosognosia. The case presented is discussed based on the need to make accurate diagnoses and propose neuropsychological rehabilitation programs so that patients with anosognosia suffer the least possible impact on the activities of their daily lives as a result of acquired brain disorder.

Recycling of plaster of Paris

Background: Plaster of Paris (POP) is being used in different ways in the field of medicine, dentistry and rehabilitation. One of its uses is in the manufacture of models of body segments in prosthetics and orthotics. It is used as a one-off procedure in which the used material is dismantled and discarded. The disposal of discarded materials does not allow easy decomposition which then pollutes the environment. It is not known whether this material could be reused if recycled. Objectives: The main objective of the study was to recycle POP models and determine its reuse in producing models with identical qualities, and thus reduce environmental pollution. Method: The procedure adopted was to break discarded models into small pieces, remove impurities and dirt; then the sample models were milled, washed, dried and pulverised. The POP models were heated to evaporate crystalline water in order to determine for how many times it could be recycled while retaining the desired strength, setting time and working characteristics. Results: The recycled POP reached higher setting temperatures and was stronger in terms of compressive strain and strength than the virgin POP. The highest temperature recorded for recycled POP was 40°C, which was higher than that for virgin powder (32.5°C). Testing compressive strength of all cylinders in all groups showed that the average compressive strength of the recycled powder mixed with water in a ratio of 1:1 was 2407 KN/m² and the ratio of 2:3 resulted in a compressive strength of 1028 KN/m², whereas the average compressive strength of virgin POP powder mixed with water in a ratio of 1:1 was 1807 KN/m² and the ratio of 2:3 resulted in a compressive strength of 798 KN/m². There were no differences in working properties between the recycled POP and the virgin POP. Conclusion: It was therefore concluded that under controlled conditions, such as grinding size, heating temperature, time and avoidance of contamination, used POP could be continuously recycled, resulting in stronger and workable casts

Research of gnostic functions in the elderly people suffering from dementia

The study was aimed at investigating the features of gnostic functions in the elderly people suffering from dementia. To implement the objectives of the study and to solve the set tasks, the following methods were used: visual gnosis tests (recognition of images, the selection of three subject pictures, selecting parts of a whole, etc.), the acoustic gnosis tests (score and perception of rhythms, recognition of nonspeech sounds), and tactile gnosis tests (tactile identification, Teuber test, Foerster test). When running the visual gnosis tests, the elderly people with the dementia diseases slowly initiated the tasks, made numerous errors, and sometimes could not cope with the tasks at all. Also, the perception integrity disorders, the presence of fragmentation, lack of accuracy, differentiation, preservation of specific objective images-objects, and the violation in the understanding of the spatial arrangement of things were revealed. When performing the auditory-motor coordination tests, the elderly people suffering from dementia needed more time to listen to, they asked for the repeated sound representation, and there were often errors in the rhythmic structure reproduction. When performing the tactile gnosis tests, the elderly people suffering from dementia had difficulties in identifying the subject by touch, in understanding the right and left-sided spatial relationships, and also made errors in recognizing one of the touches when the experimenter touched their hands. Based on the study results, the recommendations have been developed for the preservation and improvement of the existing gnostic functions' disorders in the elderly people suffering from dementia. The recommendations are complex, and they can also be useful for the medical staff whose professional activity is directly related to the elderly people suffering from dementia, their relatives and the persons closest to them.

Impacto da Anosognosia Associada à Demência de Alzheimer na Qualidade de Vida de Cuidadores / Impact of Alzheimer's disease related anosognosia in caregivers' quality of life / Impacto de la anosognosia asociada con la demencia de Alzheimer en la calidad de vida de los cuidadores

Impacto da Anosognosia Associada à Demência de Alzheimer na Qualidade de Vida de Cuidadores. A Demência de Alzheimer (DA) apresenta como um dos sintomas a anosognosia, um prejuízo na capacidade de o indivíduo julgar alterações decorrentes da doença. Relaciona-se a diversos comprometimentos cognitivo/comportamentais e é apontada como tendo significativo impacto sobre a qualidade de vida (QV) dos cuidadores. Avaliamos o impacto da anosognosia relacionada à DA sobre QV de cuidadores. Foram avaliados 50 pares paciente-cuidador com Exame Cognitivo de Addenbrooke, Questionário de Demência Ampliado e Escala de QV na DA. Observamos que cuidadores de pacientes com sinais de anosognosia apresentavam menores escores de QV, sendo que pacientes com sinais de anosognosia apresentam pior desempenho cognitivo. Escores de anosognosia e QV apresentaram correlação negativa, enquanto QV e quadro cognitivo apresentou correlação positiva. Controlando o funcionamento cognitivo, observamos que a anosognosia apresenta maior impacto na QV em indivíduos com quadro cognitivo mais grave. Palavras-chave: demência de alzheimer, qualidade de vida, cuidadores, anosognosia (AU).

Impacto de Anosognosia asociada a la demencia de Alzheimer en la calidad de vida de cuidadores. Anosognosia es uno de los síntomas de la demencia de Alzheimer (AD), y se considera que tiene un impacto significativo en la calidad de vida (QOL) de los cuidadores. Evaluamos el impacto de la anosognosia relacionada con AD en los cuidadores de calidad de vida. Hubo 50 pares paciente y su cuidador con el examen cognitivo de Addenbrooke, Cuestionario Ampliado de y Escala de calidad de vida. Hemos observado que los cuidadores de pacientes con signos anosognosia tenían menores puntuaciones de calidad de vida con los pacientes con peor rendimiento cognitivo. Anosognosia y la calidad de vida mostraron una correlación de negativa, mientras que la calidad de vida y el marco cognitivo presentaron correlación positiva. Controlando el funcionamiento cognitivo, observamos que la anosognosia tiene mayor impacto en la calidad de vida en pacientes con marco cognitivo más severo. Palabras clave: enfermedad de alzheimer, calidad de vida, cuidadores, anosognosia (AU).

Alzheimer's disease (AD) has anosognosia as one of its symptoms, defined as a change in the individual's ability to judge their difficulties, and is observed as having a significant impact on quality of life of caregivers. This study evaluated the impact of anosognosia related to AD in quality of life (QoL) of caregivers. Fifty AD patients were evaluated through the Addenbrooke's Cognitive Examination, Dementia Questionnaire ­ expanded, while caregivers were evaluated using the Scale of QoL in AD and Dementia Questionnaire (caregiver versions). We observed that caregivers of patients with signs of anosognosia had lower scores on QoL and these patients had worse cognitive scores. Anosognosia and QoL were negatively correlated, as QoL and cognitive functioning. Controlling for cognitive functioning, we observed that anosognosia has a greater impact on QoL in individuals with more severe cognitive impairments (AU).

Gerstmann's syndrome and unilateral optic ataxia in the emergency department / Síndrome de gerstmann e ataxia óptica unilateral na sala de emergência

ABSTRACT. A 75-year-old right-handed woman presented to the emergency department with simultanagnosia and right unilateral optic ataxia. Moreover, the patient had agraphia, acalculia, digital agnosia and right-left disorientation, consistent with complete Gerstmann's syndrome. This case highlights the concurrence of Gerstmann's syndrome and unilateral optic ataxia in the acute phase of a left middle cerebral artery stroke.

RESUMO. Uma paciente de 75 anos e destra se apresentou à sala de emergência com quadro de simultanagnosia e ataxia óptica unilateral à direita. Além disso, a paciente tinha agrafia, acalculia, agnosia digital e desorientação direita-esquerda, compatíveis com a síndrome de Gerstmann. O presente caso destaca a ocorrência simultânea da síndrome de Gerstmann com ataxia óptica unilateral na fase aguda do acidente vascular cerebral da artéria cerebral média esquerda.

Las agnosias auditivas: una revisión teórica / Auditory agnosias: a theoretical review

Las agnosias auditivas son consideradas un déficit en la percepción y/o en el reconocimiento de los sonidos, en ausencia de pérdida auditiva, manteniendo indemnes las habilidades cognitivas y lingüísticas. Si bien la mayoría de las agnosias auditivas se deben a lesiones orgánicas, principalmente accidentes cerebrovasculares, también existen casos en donde los déficits son congénitos. La presente revisión teórica esquematiza los principales tópicos concernientes a esta patología, presentando además un modelo neuropsicológico del procesamiento auditivo de los objetos y sus trastornos. Se realizó un estudio teórico de tipo clásico, en donde se seleccionan de manera direccionada los artículos pertinentes a la temática, utilizando como base de datos primaria a Medline. Por otra parte, se complementa la búsqueda con investigaciones afines y capítulos de libros que no fueron considerados en la búsqueda principal. Se concluyó que, si bien existe un amplio conocimiento en torno a este tema, principalmente en idioma inglés, éste aún es insuficiente. Por tanto, es necesario seguir realizando investigaciones, de modo que se pueda obtener mayor cantidad de artículos con la mayor evidencia disponible, es decir, del tipo meta-análisis, ensayos clínicos aleatorizados y revisiones sistemáticas de la literatura.

Auditory agnosias are considered as a deficit in the perception and/or recognition of sounds, in the absence of hearing loss, and with cognitive and linguistic skills indemnity. Although most auditory agnosias are due to organic lesions, mainly strokes, nontheless there are also cases where the deficits are congenital. A theoretical study of classic type was realized, in which the articles pertinent were selected using as main database Medline. On the other hand, the serach was complemented with related stuides, and book chapters that were not considered in the main search. It was concluded that, although there is extensive knowledge on this subject, mainly in English, it is still insufficient. Therefore, further research is necessary to obtain higher quality articles, like meta-analysis, randomized clinical trials and systematic reviews.

The Neuro-ophthalmic Presentation of Intracranial Aneurysms

PURPOSE: To investigate the neuro-ophthalmic diagnosis and clinical manifestations of intracranial aneurysm. METHODS: A retrospective survey of 33 patients who were diagnosed with intracranial aneurysm and underwent neuro-ophthalmic examination from April 2008 to December 2016. Frequency of the first diagnosis of intracranial aneurysm in ophthalmology, neuro-ophthalmic diagnosis, location of intracranial aneurysm, examination of intracranial aneurysm rupture, and neurologic prognosis of Terson's syndrome patients were analyzed by image examination, neurosurgery, and ophthalmology chart review. RESULTS: Of the 33 patients, most patients (n = 31, 94%) were diagnosed with intracranial aneurysm at the neurosurgical department and only 2 patients were diagnosed initially at the ophthalmology department. Causes and association were: Terson's syndrome (n = 10, 30%), third cranial nerve palsy (n = 10, 30%), internclear ophthalmoplegia (n = 4, 12%), visual field defect (n = 3, 9%), optic atrophy (n = 3, 9%), sixth cranial nerve palsy (n = 2, 6%), and nystagmus (n = 1, 3%). The location of intracranial aneurysms were: anterior communicating artery (n = 13, 39%), medial communicating artery (n = 12, 36%), and posterior communicating artery (n = 5, 15%). Ten of 33 patients had Terson's syndrome, and 6 patients (60%) with Terson's syndrome had apermanent neurological disorder such as agnosia, gait disorder and conduct disorder. CONCLUSIONS: Third cranial nerve palsy was the most common neuro-ophthalmic disease in patients presenting with intracranial aneurysm. The neuro-ophthalmic prognoses for those diseases were relatively good, but, if Terson's syndrome was present, neurological disorders (agnosia, gait disorder, conduct disorder) were more likely to remain after treatment.

Presence or absence of cognitive complaints in Parkinson's disease: mood disorder or anosognosia? / Presença ou ausência de queixas cognitivas na doença de Parkinson: transtorno de humor ou anosognosia?

ABSTRACT We intended to evaluate whether non-demented Parkinsons’s disease (PD) patients, with or without subjective cognitive complaint, demonstrate differences between them and in comparison to controls concerning cognitive performance and mood. We evaluated 77 subjects between 30 and 70 years, divided as follows: PD without cognitive complaints (n = 31), PD with cognitive complaints (n = 21) and controls (n = 25). We applied the following tests: SCOPA-Cog, Trail Making Test-B, Phonemic Fluency, Clock Drawing Test, Boston Naming Test, Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory. PD without complaints presented lower total score on Scales for outcome of Parkinson’s disease-cognition as compared to controls (p = 0.048). PD with complaints group showed higher scores on HADS (p = 0.011). PD without complaints group showed poorer cognitive performance compared to controls, but was similar to the PD with complaints group. Moreover, this group was different from the PD without complaints and control groups concerning mood.

RESUMO Avaliar se pacientes com doença de Parkinson (DP) sem demência, com ou sem queixa cognitiva subjetiva, demonstram diferenças entre eles e comparativamente aos controles relativos a desempenho cognitivo e humor. Avaliados 77 indivíduos entre 30 e 70 anos: PD sem queixas cognitivas (n = 31), PD com queixas cognitivas (n = 21) e controles (n = 25). Testes aplicados: SCOPA-cognição, Trail Making Test-B, Fluência Fonêmica, Teste do Relógio, Teste Nominativo de Boston, Inventário Neuropsiquiátrico, Escala Hospitalar de Depressão e Ansiedade (HADS)e Inventário de Depressão de Beck. PD sem queixas apresentaram menor pontuação total na SCOPA-cognição, comparativamente aos controles (p = 0,048). Por outro lado, PD com queixas apresentaram maior pontuação no HADS (p = 0,011) em comparação aos controles. O grupo PD sem queixas mostrou pior desempenho cognitivo em comparação aos controles, mas foi semelhante ao PD com queixas. Este grupo foi diferente dos grupos PD sem queixas e controle em relação ao humor.

Imagem e esquema corporal de hemiparéticos por lesão encefálica direita devido a acidente vascular encefálico e traumatismo crânio-encefálico / Body image and scheme of brain injury in right hemiparetics due to vascular brain accident and traumatic brain injury

O conhecimento sobre esquema e imagem corporal é fundamental para o trabalho fisioterapêutico tendo em vista o impacto que as alterações da percepção corporal geram na qualidade de vida de indivíduos com lesão cerebral, sobretudo em hemiparéticos. Neste sentido, este trabalho analisou a percepção da imagem e esquema corporal de indivíduos com lesão hemisférica direita por Acidente Vascular Encefálico e Traumatismo Crânio-Encefálico. Metodologicamente, este estudo é caracterizado como quali-quantitativo, sendo instrumentalizado pelas avaliações de Propriocepção, de Comando Verbal, pela autorrepresentação gráfica do corpo e por relatos realizados durante a execução desta em 12 sujeitos hemiparéticos. Os dados de Propriocepção e Comando Verbal foram analisados por medidas de tendência central através do software SPSS e a análise dos relatos através do método de Análise de Conteúdo proposto por Bardin. Os resultados mostraram que a avaliação da Propriocepção apresentou maior índice de alteração na flexão de punho e de dedos e o de Comando Verbal no item "Toque sua mão esquerda com sua mão direita". A auto representação gráfica, assim como a Análise de Conteúdo dos relatos evidenciaram alterações de imagem em todos os indivíduos. Os resultados também apontaram significações diferenciadas das alterações de esquema e imagem quando relacionados à faixa etária e ao tempo de lesão. Conclui-se que a imagem e esquema corporais devem ser melhor investigados e relacionados ao processo de reabilitação, objetivando um bom prognóstico em quadros de hemiparesia.

Avaliação comportamental do processamento auditivo pré e pós treinamento auditivo formal em indivíduos após traumatismo cranioencefálico / Behavioral assessment of auditory processing before and after formal auditory training in traumatic brain injury patients

Objetivo : Verificar os efeitos do treinamento auditivo formal em indivíduos após traumatismo cranioencefálico, utilizando testes comportamentais. Métodos : Nove indivíduos audiologicamente normais, que haviam sofrido traumatismo cranioencefálico grave, com lesão axional difusa, com ou sem lesão focal associada, foram submetidos à avaliação comportamental do processamento auditivo pré e pós treinamento auditivo formal em cabina acústica, organizado em oito sessões, visando o treinamento das habilidades auditivas de ordenação temporal, fechamento auditivo e figura-fundo. Resultados : Observou-se melhora no desempenho em todos os testes, após o treinamento, refletindo em uma melhora das habilidades auditivas de ordenação temporal e figura-fundo, para sons verbais. Quanto aos processos gnósicos alterados, observou-se melhora significativa para codificação (perda gradual de memória e integração sensorial) e organização. Conclusão : Indivíduos com lesão axional difusa, após sofrerem traumatismo cranioencefálico grave, apresentaram adequação das habilidades auditivas de figura-fundo, ordenação e resolução temporal, evidenciadas na avaliação comportamental do processamento auditivo, pós treinamento auditivo formal. .

Purpose : To investigate the effects of formal auditory training on individuals with traumatic brain injury using behavioral tests. Methods : Nine normal hearing individuals who had severe traumatic brain injury underwent behavioral evaluation of auditory processing pre and post formal auditory training. Eight sessions took place in an attempt to train the auditory skills of temporal ordering, auditory closure and figure-ground. Results : All individuals improved in all tests after the training, improving the auditory skills of temporal ordering and figure-ground of verbal sounds. In terms of the altered gnosis processes, a significant improvement was found for encoding (gradual loss of memory and sensory integration) and organization. Conclusion : After formal auditory training, individuals with severe traumatic brain injury exhibited adequacy in the auditory skills of figure-ground, temporal ordering and resolution. .

Restoring awareness: a review of rehabilitation in anosognosia for hemiplegia

Disturbances in body awareness offer important insights into neurocognitive processes involved in the construction of the bodily self. This review will focus ona specific disorder of awareness, namely, anosognosia for hemiplegia (AHP), or the denial of motor deficits contralateral to a brain lesion. Recently some progress has been made towards the management and rehabilitation of AHP, however to date no evidence-based treatment exists. Firstly, recent research on AHP will be reviewed, with the aim of providing an overview of the etiology, clinical presentation and assessment of the syndrome, as well as the majorneurological and neuropsychological explanations. This article will then focus on recent advances in the management and rehabilitation of AHP, using a casestudy example of intervention-based (i.e. video replay) motor awareness recovery (Fotopoulou, Rudd, Holmes & Kopelman, 2009). Finally, a dynamic theoreticalmodel of the multifaceted nature of anosognosia, using a predictive coding framework, will be proposed and future directions for research will also be discussed...

Kluver-Bucy Syndrome Following Bilateral Posterior Cerebral Artery Infarction

Kluver-Bucy syndrome is defined as a rare neurobehavioral disorder with hyperphagia, hyperorality, hypersexuality, and visual agnosia. This syndrome is usually resulting from bilateral lesions of the anterior temporal lobe including amygdala. Although it could occur after various diseases, stroke is uncommon etiology. We report a patient with Kluver-Bucy syndrome due to bilateral posterior cerebral artery territory infarction.

Dos casos de atrofia cortical posterior, la demencia que inicia con síntomas visuales / Two cases of posterior cortical atrophy a dementia that begins with visual symptoms

Presentamos dos casos de demencia de inicio antes de los 65 años de edad con apraxia y manifestaciones visuo-espaciales, en los cuales no hay trastornos de memoria y de la conducta, y con diferentes grados de evolución ademencia. Las imágenes estructurales del cerebro demuestran atrofia parieto-occipital. Ambos casos reúnen los criterios de atrofia cortical posterior (ACP).

We present two cases of progressive early, onset dementia with apraxia and visuospatial disability as initial manifestations, in which there is no memory and behavior disorders, and with different degrees of progression to dementia. Structural neuroimaging demonstrated parieto-occipital atrophy. These cases fulfil the diagnostic criteria of posterior cortical atrophy (PCA).

Posterior cortical atrophy - a prototypical case of dementia beginning with visual symptoms: case report / Atrofia cortical posterior - um caso prototípico de demência iniciando com sintomas visuais: relato de caso

Dementia presenting with prominent higher order visual symptoms may be observed in a range of neurodegenerative conditions and is often challenging to diagnose. We describe a case of progressive dementia presenting with prominent visual cortical symptoms. A 55-year-old, right-handed, woman with early onset of visual impairment not associated with anterior visual pathology, presenting with dyslexia, visual agnosia, Balint's syndrome, and spatial disorientation. Ophthalmologists should consider this condition especially in presenile patients with slowly progressive higher-order visual symptoms. Although described in association with different conditions, it may also occur in Alzheimer disease.

As demências que se apresentam predominantemente com sintomas visuais associativos podem ser observadas em diferentes condições neurodegenerativas, sendo seu diagnóstico muitas vezes desafiador. Descrevemos um caso com demência progressiva que se apresentam com sintomas visuais proeminentes. Mulher de 55 anos, destra, com início precoce de déficits visuais não associados a patologia visual anterior, apresentando dislexia, agnosia visual, síndrome de Balint e desorientação espacial. Os oftalmologistas devem ter em mente essa condição especialmente em pacientes pré-senis com queixas visuais complexas e lentamente progressivas. Apesar de descritas em diferentes condições, pode ocorrer na doença de Alzheimer.

Cognitive anosognosia and behavioral changes in probable Alzheimers disease patients / Anosognosia cognitiva e alterações comportamentais em pacientes com provável doença de Alzheimer

Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. OBJECTIVE: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). METHODS: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. RESULTS: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic-DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. CONCLUSION: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.

Anosognosia, comprometimento do insight e ausência de reconhecimento de déficits são usados como termos equivalentes neste estudo. OBJETIVO: Investigar a relação entre a presença de sintomas de anosognosia e domínios cognitivos, habilidades funcionais, e sintomas neuropsiquiátricos em pacientes com provável doença de Alzheimer (pAD) e idosos controles. MÉTODOS: vinte e um pDA (14 mulheres) e vinte e dois EC (16 mulheres) foram submetidos a uma bateria neuropsicológica de testes avaliando o estado cognitivo global, e funções cognitivas específicas: memória, funções executivas e atencionais, fluência verbal e habilidades visoconstrutivas. Adicionalmente, habilidades funcionais (FAQ) e sintomas neuropsiquiátricos (NPI) foram avaliados. RESULTADOS: Teste estatístico de regressão linear indicou uma associação entre anosognosia e queixas subjetivas de memória, idade e aritmética-DRS no grupo controle. Por outro lado, aritmetica-DRS, IQCODE e FAQ (habilidades cognitivas e funcionais) foram melhores predictores nos pacientes com pDA, especificamente para consciência das alterações comportamentais. CONCLUSÃO: Os resultados indicaram que diferentes variáveis estão associadas com auto-percepção nos pacientes com pDA e controles, porém para ambos os grupos parece que o funcionamento executivo tem um papel importante contribuindo principalmente na percepção das alterações comportamentais.

Processos comunicativos dos indivíduos com lesão do hemisfério direito / Communicative processes of individuals with injuries of the right cerebral hemisphere

Objetivo: O presente estudo teve como objetivo traçar o perfil de linguagem de pacientes com lesão de hemisfério direito atendidos na Associação de Assistência a Criança Deficiente (AACD/Unidade Ibirapuera - Central), bem como verificar a percepção dos cuidadores e dos pacientes em relação à presença ou não de alterações de linguagem pós-acidente vascular cerebral. Método: O estudo descritivo foi desenvolvido de julho a setembro de 2009 com 11 indivíduos adultos por meio da aplicação da Bateria Montreal de Avaliação da Comunicação/Bateria MAC, prova Questionário sobre a Consciência das Dificuldades e o questionário Triagem de Distúrbios Comunicativos em Indivíduos com quadro neurológico, direcionado aos familiares e/ou cuidadores. Resultados: Verificou-se que 90,9% dos pacientes com Lesão de Hemisfério Direito apresentaram déficit em pelo menos uma das provas que compunham a Bateria MAC de avaliação da linguagem. Conclusão: Mostra-se também de extrema importância o achado relacionado à ausência de percepção dos pacientes em relação as suas próprias alterações linguístico-cognitivas, não pela inexistência de impactos em sua vida diária, mas devido à agnosia.

Objective: This study aimed to profile the language skills of patients with damage to the right cerebral hemisphere attended at the Ibirapuera Unit (Central) of the Association for the Welfare of Handicapped Children - AACD (Associação de Assistência à Criança Deficiente - AACD/Unidade Ibirapuera - Central), and to discover the perceptions of caregivers and patients regarding the presence or absence of language disorders after a stroke. Method: The descriptive study was conducted from July to September of 2009 with 11 adults through the application of the Montreal Communication Evaluation Battery (known in Brazil as Bateria MAC) tests, the Questionnaire on Awareness of Difficulties, and the Communicative Disorders Screening on individuals with neurological conditions, direct relatives, and/or caregivers. Results: It was found that 90.9% of patients with injuries of the right cerebral hemisphere had a deficit in at least one of the tests comprising the Bateria MAC assessment of language. Conclusion: Findings showing the patient?s absence of awareness of their linguistic and cognitive deficits are also very important, not only about their daily life activities, but about their agnosia.

Clinical Progress of Gerstmann's Syndrome with Left Frontal Lobe Lesion: Two Cases

Gerstmann's syndrome, assigned to a lesion of the dominant parietal lobe, is a neurological disorder characterized by acalculia, agraphia, right-left disorientation and finger agnosia. Some studies report that these symptoms are also shown in other brain lesions. We report two patients who presented with this tetrad of symptoms in initial assessment. Their Brain MRI images both showed lesion of left frontal lobe. Over time, these symptoms became better but some still remained in last assessment. Accordingly, we suggest that a left frontal lesion cause Gerstmann's syndrome.