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.

"I don't have Huntington's disease": the boundaries between acceptance and understanding / "Eu não tenho doença de Huntington": os limites entre aceitação e compreensão

Abstract Huntington's disease (HD) is an inherited disease that leads to an inexorable progression of motor, cognitive and psychiatric disturbances. In the initial stages, the symptoms are not clearly disabling, and the patient may present a lack of awareness about the symptoms themselves, which we call anosognosia. However, anosognosia might not justify all passivity of the HD patient in face of the diagnosis. Patients may also experience the denial of illness, as a stage of grief, expected to happen in the face of the diagnosis of any neurodegenerative disorder. In addition, people with HD tend to be more apathetic, and more silent, in regular consultations. In the present article, the authors express a point of view, discussing the behavior of the HD patient, in which there is a multifactorial passivity, in the face of the diagnosis and of the disease itself. Having the proper knowledge of this situation may prepare the neurologist to better understand the patient and the evolution of the disease.

Resumo A doença de Huntington (DH) é uma doença hereditária que leva a uma progressão inexorável de distúrbios motores, cognitivos e psiquiátricos. Nos estágios iniciais, os sintomas não são claramente incapacitantes e há uma falta de consciência sobre os próprios sintomas, o que chamamos de anosognosia. No entanto, anosognosia pode não justificar toda a passividade do paciente de HD diante do diagnóstico. Os pacientes também podem vivenciar a negação da doença, como um estágio de luto, o que é esperado acontecer diante do diagnóstico de qualquer doença neurodegenerativa. Além disso, as pessoas com DH tendem a ficar mais apáticas, mais silenciosas, nas consultas regulares. No presente artigo, os autores expressam um ponto de vista, discutindo acerca do comportamento do paciente com DH, em que há uma passividade multifatorial, frente ao diagnóstico e diante da doença em si. Ter conhecimento sobre essa situação pode preparar o neurologista para entender melhor o paciente e a evolução da doença.

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)

Case of Left Thalamic Hemorrhage and Presumed Presence of Multimodal Agnosia / The Japanese Journal of Rehabilitation Medicine

We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.

Case of Left Thalamic Hemorrhage and Presumed Presence of Multimodal Agnosia / The Japanese Journal of Rehabilitation Medicine

We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.

El "efecto Tortoni" en la prosopagnosia / The "Tortoni effect" in prosopagnosia

Resumen La prosopagnosia es un tipo de agnosia visual caracterizada por la incapacidad de reconocer los rostros de las personas. Existen básicamente dos variantes, aperceptivas y asociativas. El "efecto Tortoni" es un fenómeno descripto por Bekinschtein y col. hace unos años en mozos de café en Buenos Aires, quienes utilizaban esta herramienta para recordar los pedidos de cada integrante de una mesa. Presentamos un caso de prosopagnosia asociada a lesión temporo-occipital bilateral secundaria a traumatismo encefalocra neano, manifestada en forma inicial por la falta de reconocimiento de rostros, con la utilización de una estra tegia asociativa similar a la descripta en el efecto "Tortoni" como compensación. Mujer de 62 años que sufrió un traumatismo encefalocraneano grave. Pocos meses después del evento, presentó dificultad para reconocer personas conocidas, hecho evidenciado por sus allegados cuando en una mesa los integrantes cambiaron su asiento, permanecieron callados por unos instantes, y posteriormente la paciente continuó nombrándolos por su ubicación previa. En la resonancia magnética de cerebro se objetivaron lesiones contusas de aspecto secuelar en región temporo-occipital bilateral. La prosopagnosia adquirida secundaria a lesiones focales en la región temporo-occipital generalmente bilateral, derecha, y raramente izquierda, es un cuadro poco frecuente. La es trategia utilizada en el "efecto Tortoni" fue en nuestra paciente una de las manifestaciones iniciales del cuadro. La realización de un test neuropsicológico ecológico que considere esta estrategia podría ser de utilidad en el rastreo y detección precoz de esta entidad.

Abstract Proposapnosia is a type of visual agnosia characterized by the inability to recognize people's faces. There are basically two variants, apperceptive and associative. The "Tortoni effect" is a phenomenon described by Bekinschtein et al a few years ago in waiters from Buenos Aires, who used this tool to remember the orders of each member of a table. We present a case of prosopagnosia associated with bilateral temporo-occipital injury secondary to head trauma, initially manifested by the lack of face recognition with the use of an associative strategy similar to that described in the "Tortoni effect" as compensation, in a 62-year-old female who suffered a severe head injury. A few months after this event, the patient had difficulty in recognizing familiar people, a fact evidenced by her relatives when at a restaurant table, they changed their seats, remained silent momentarily, and right after the patient kept naming them by their previous location. The magnetic resonance imaging of the brain revealed blunt sequelae lesions in the bilateral temporo-occipital region. Acquired prosopagnosia due to focal lesions in the temporo-occipital region, generally bilateral and right, and less frequently left, is a rare condition. The strategy used in the "Tortoni effect" was one of the initial manifestations of the condition in our patient. Carrying out an ecological neuropsychological test that considers this strategy could be useful in the screening and early detection of this entity.

Rehabilitation for Stroke with Auditory Agnosia as the First Symptom: Four Cases Report / 中国康复理论与实践

Objective:To study the clinical characteristics, diagnosis, treatment and rehabilitation of auditory agnosia after stroke. Methods:Four stroke inpatients with auditory agnosia as the first symptom from January, 2016 to August, 2018 were reviewed. Results:All the patients started with auditory impairment, followed with motor dysfunction and speech impairment. They had a previous history of cerebrovascular disease once or more, and were finally diagnosed as auditory agnosia after stroke. After comprehensive rehabilitation treatment, all the patients could walk independently, and the activities of daily living were improved. Some patients could discriminate environmental sound, but still were poor in listening comprehension. Conclusion:Post-stroke auditory agnosia is rare, with poor outcome, which needs comprehensive assessment, speech perception training and non-verbal communication training to improve the communication.

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.

The charming physician (El médico encantador): neurological conditions in a short story by Silvina Ocampo / O médico encantador (El médico encantador): doenças neurológicas em um conto de Silvina Ocampo

ABSTRACT The Argentinian author Silvina Ocampo (1903-1993) left us a vast body of works which are considered outstanding in many ways. In 1960, she published a short story, entitled "El médico encantador" (The Charming Physician), in the renowned literary magazine Sur. The central character of this piece is a family doctor named Albino Morgan, who had a secret truth: in any house he visited, all variety of disease also entered. He brought with him the viruses he disseminated. The narrator of this short story—one of his patients—describes four of Morgan's diseases. These imaginary neurological conditions allowed Ocampo to explore improbable situations in everyday life.

RESUMO A autora argentina Silvina Ocampo (1903-1993) deixou-nos uma vasta obra que é considerada excelente de várias maneiras. Em 1960, publicou um conto, intitulado "El médico encantador" (O médico encantador), na famosa revista literária Sur. O personagem principal desta obra é um médico de família chamado Albino Morgan que possuía uma verdade secreta: em qualquer casa que ele visitava, também entrava toda a diversidade de doenças. O narrador deste conto -um dos seus pacientes- descreve quatro das doenças de Morgan. Estas condições neurológicas imaginárias permitiu a Ocampo explorar as situações improváveis da vida quotidiana.

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.

Síndrome de Gerstmann completo / Whole Gerstmann syndrome

El síndrome de Gerstmann es una rara enfermedad neurológica de causa vascular que afecta al lóbulo parietal. Se reporta el caso de un paciente masculino de 63 años con antecedentes patológicos personales de miocardiopatía dilatada. El 24 de enero de 2016 en horas de la mañana presentó de forma súbita pérdida de la conciencia con caída al suelo. Después de recuperarse tuvo estado confusional, desorientación topográfica de breve duración y dificultad para la expresión del lenguaje y la nominación de los objetos, por esta causa se decide su ingreso, durante el cual se realiza resonancia magnética simple de cráneo donde se observó imagen hipointensa en FLAIR en región parietal izquierda compatible con lesión isquémica. Se efectuó evaluación neuropsicológica encontrándose: agnosia digital, agrafia, acalculia y confusión derecha-izquierda. Se diagnostica un síndrome de Gerstmann completo(AU)

Gerstmann syndrome is a rare neurological disease of vascular cause that affects the parietal lobe. The case is reported of a 63-year-old male patient with a personal pathological history of dilated cardiomyopathy. In the morning of January 24, 2016, the patient presented sudden loss of consciousness with a fall to the ground. After recovering, he experienced a confusion state, short-lived topographical disorientation, and difficulty in expressing language and the naming of objects, a reason why his admittance was decided. During the admittance, simple magnetic resonance imaging to the skull was performed, which permitted to observe a hypo-intense image in FLAIR in the left parietal region and that was compatible with an ischemic lesion. A neuropsychological evaluation was performed: digital agnosia, agraphia, acalculia and confusion regarding right or left. A whole Gerstmann syndrome was diagnosed.(AU)

Acute Auditory Agnosia Resulted from MELAS Syndrome / 听力学及言语疾病杂志

Objective To investigate the clinical features,etiology,diagnosis and treatment of acute auditory agnosia.Methods We studied the clinical manifestation,diagnosis and treatment of acute auditory agnosia in a patient in our hospital.Results A 28 year oldyoung woman visited our department because she suffered from the tinnitus for 7 days and she could not distinguish the semantics for 1 day.There were no other abnormal symptoms in the central and peripheral nervous system on admission.Audiological testing showed normal,language testing showed that the speech discrimination score was zero.MRI showed extensive damage to temporal lope.MR spectroscopy revealed increased lactate and reduced N-acetyl aspartate.Acute auditory agnosia resulted from mitochondrial myopathy was considered.After symptomatic treatment,the symptoms were significantly improved.Molecular genetics examination showed the A3243G mtDNA mutation,further confirmed the diagnosis of mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes (MELAS) syndrome.Conclusion Acute auditory agnosia and acute tinnitus can be the first symptoms in MELAS,thus,MELAS should be suspected in patients with acute auditory agnosia,acute tinnitus,sudden hearing loss in children and youth.Imaging examination plays an important role in the etiological diagnosis of acute auditory agnosia.

Sistema de Apoyo Experimental para el Reconocimiento Visual y el Nombrado de Objetos / Experimental support system for visual recognition and object nomination

Resumen: En la práctica clínica relacionada con la rehabilitación cognitiva, perceptual y del lenguaje, es habitual emplear como estímulos representaciones de objetos en dos dimensiones como dibujos o fotografías para que sean identificados por los pacientes. Ello supone una limitación, puesto que la presentación de objetos en tres dimensiones, dada su mayor riqueza visual, facilita su identificación y podría apoyar procesos de rehabilitación. Objetivo: Diseñar una configuración experimental para conocer el grado en que las modalidades de presentación de estímulos afectan el reconocimiento visual de objetos. Materiales y Métodos: Se diseñó un sistema de bajo costo para mostrar estímulos en tres modalidades: imágenes, videos y objetos reales. Fueron seleccionados 80 objetos, controlando las variables de manipulabilidad, edad de adquisición, familiaridad, complejidad visual y frecuencia léxica. Se realizó una prueba piloto utilizando el sistema con cinco personas sanas y se midieron los tiempos de reacción en la nominación de los objetos. Resultados: Las diferencias en los tiempos de reacción entre las modalidades observadas apoyan la influencia de la modalidad de presentación en el reconocimiento de objetos. Conclusiones: Las propiedades de volumen de los objetos permitirían la exploración de características que las fotografías no tendrían; razón por la cual, los tiempos de reacción para los objetos reales y los videos fueron menores. Son valiosos los aportes que ofrecen una alternativa de bajo costo para la visualización y el reconocimiento de objetos.

Abstract: A wide variety of stimuli or objects such as drawings or photographs are used in cognitive perceptual and language rehabilitation. However, the presentation of objects in three dimensions, due to the visual richness, facilitates the identification and could support the rehabilitation process. Objective: Design an experimental setup to determine the extent to which the modality of presentation of objects affects the visual recognition of objects. Materials and methods: A low-cost experimental system was designed in order to show the stimulus in three ways: images, videos and real objects. Eighty objects were selected and variables as manipulability, age of acquisition, familiarity, visual complexity, agreement on the label and lexical frequency were controlled. A pilot study was conducted using the system in five healthy participants and the reaction time to identify objects was measured. Results: The findings reveal that the differences in reaction times between the modalities of presentation support the influence of the mode of presentation in object recognition. Conclusions: The volume object properties could allow the exploration of characteristics that the photographs would not have. This may be why the reaction time to identify real objects or videos was lower. Low-cost alternatives for the visualization and object recognition are valuable in cognitive perceptual and language rehabilitation.

Demencia frontotemporal: variante temporal derecha, reporte de dos casos / Frontotemporal Dementia: Right Temporal Variant, report of 2 cases

La demencia frontotemporal derecha es una variante anatómica de la demencia frontotemporal. Se asocia con síntomas cognitivos y comportamentales característicos, entre los que se destacan: agnosia topográfica, desorientación espacial, prosopagnosia, conductas obsesivas, agresividad, impulsividad, desinhibición y pérdida de la empatía. Se reportan dos casos, que desde el punto de vista clínico e imaginológico, resultan ilustrativos de la variante derecha en la demencia frontotemporal.

Right temporal frontotemporal dementia is an anatomic variant of frontotemporal dementia. It is associated with some characteristic behavioral and cognitive symptoms: topographic agnosia, spatial disorientation, prosopagnosia, obsessive behaviors, aggressiveness, impulsiveness, disinhibition and lack of empathy. Here we report two clinical cases, that, from a clinical and radiologic point of view, illustrate the right variant of frontotemporal dementia.

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.

Damage Level and Mechanism of Language Processing in An Auditory Agnosia Patient Using Psycholinguistic As-sessment / 中国康复理论与实践

Objective To evaluate the damaged level of auditory processing and diagnose the type of language impairment in an audito-ry agnosia patient using Psycholinguistic Assessment in Chinese Aphasia (PACA), and predict the outcome of the language function. Meth-ods A patient with a bilateral damage involving the temporal lobe could physically hear the sounds, but was unable to recognize or differenti-ate between the sounds. Speech and language evaluations were taken with PACA 4 weeks, 8 weeks and 3 months after the onset of disease. Results At 4 weeks, the correct rates were 2.5%and 95.0%in spoken word-picture matching and written word-picture matching (P<0.001), and were 5.6%and 80.6%in spoken semantic knowledge and written semantic knowledge (P<0.001). The scores of auditory input process-ing function score were low, including phoneme discrimination, spoken word matching with minimal differences, environmental sounds identification. The correct rates were 67.5%in oral picture naming, 0 in word repetition, 70.0%in word reading, 0 in dictation, 100.0%in di-rectly copy writing. At 8 weeks and 3 months, there was complete recovery in written word-picture matching (both 100%) and written se-mantic knowledge (97.2%, 100%), and improvement in oral picture naming (87.5%, 90%), word repetition (87.5%, 97.5%), picture name writing (77.5%, 87.5%) and copy writing (both 100%) (P<0.05). But no change was found in auditory input processing function examina-tions, spoken word-picture matching (5.0%, 7.5%), spoken semantic knowledge (2.8%, 5.6%), word repetition (0, 3.3%) and dictation (both 0). Conclusion The patient was diagnosed as auditory agnosia with the inability to distinguish sounds. PACA can well identify the impaired level of auditory comprehension disorder and the outcome of language function recovery for aphasics.

Damage Level and Mechanism of Language Processing in An Auditory Agnosia Patient Using Psycholinguistic Assessment / 中国康复理论与实践

@#Objective To evaluate the damaged level of auditory processing and diagnose the type of language impairment in an auditory agnosia patient using Psycholinguistic Assessment in Chinese Aphasia (PACA), and predict the outcome of the language function. Methods A patient with a bilateral damage involving the temporal lobe could physically hear the sounds, but was unable to recognize or differentiate between the sounds. Speech and language evaluations were taken with PACA 4 weeks, 8 weeks and 3 months after the onset of disease. Results At 4 weeks, the correct rates were 2.5% and 95.0% in spoken word-picture matching and written word-picture matching (P<0.001), and were 5.6% and 80.6% in spoken semantic knowledge and written semantic knowledge (P<0.001). The scores of auditory input processing function score were low, including phoneme discrimination, spoken word matching with minimal differences, environmental sounds identification. The correct rates were 67.5% in oral picture naming, 0 in word repetition, 70.0% in word reading, 0 in dictation, 100.0% in directly copy writing. At 8 weeks and 3 months, there was complete recovery in written word- picture matching (both 100%) and written semantic knowledge (97.2%, 100%), and improvement in oral picture naming (87.5%, 90%), word repetition (87.5%, 97.5%), picture name writing (77.5%, 87.5%) and copy writing (both 100%) (P<0.05). But no change was found in auditory input processing function examinations, spoken word-picture matching (5.0%, 7.5%), spoken semantic knowledge (2.8%, 5.6%), word repetition (0, 3.3%) and dictation (both 0). Conclusion The patient was diagnosed as auditory agnosia with the inability to distinguish sounds. PACA can well identify the impaired level of auditory comprehension disorder and the outcome of language function recovery for aphasics.

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).

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.

A Case of Generalized Auditory Agnosia with Unilateral Subcortical Brain Lesion

The mechanisms and functional anatomy underlying the early stages of speech perception are still not well understood. Auditory agnosia is a deficit of auditory object processing defined as a disability to recognize spoken languages and/or nonverbal environmental sounds and music despite adequate hearing while spontaneous speech, reading and writing are preserved. Usually, either the bilateral or unilateral temporal lobe, especially the transverse gyral lesions, are responsible for auditory agnosia. Subcortical lesions without cortical damage rarely causes auditory agnosia. We present a 73-year-old right-handed male with generalized auditory agnosia caused by a unilateral subcortical lesion. He was not able to repeat or dictate but to perform fluent and comprehensible speech. He could understand and read written words and phrases. His auditory brainstem evoked potential and audiometry were intact. This case suggested that the subcortical lesion involving unilateral acoustic radiation could cause generalized auditory agnosia.