Palatal morphology changes in post-stroke patients measured by geometric morphometrics.

This study aimed to describe longitudinal palatal shape changes in post-stroke patients when compared to a sample of healthy subjects through linear measurements and geometric morphometrics. The 3D palatal scanned models of seven stroke patients having a 1-year post-stroke follow-up were matched with seven control subjects of the same age group (range 50-87 years). Intercanine, intermolar distances and palatal height were measured. 3D images were also analysed through geometric morphometrics to assess changes in the shape of the palate from T0 to T1 (1 year after the stroke). Principal component analysis was used to describe shape morphology changes, and visual colour maps were used to qualitatively assess differences between T0 and T1. No changes were detected nor in linear measures neither in palatal shape in healthy subjects from T0 to T1. The palates of stroke patients showed no linear differences either. However, when visualising shape changes through colour maps, the lateral aspects of the palatal vault were slightly narrower in T1, with respect to T0 in stroke patients. This may be attributed to altered tongue function following the stroke.

Oral tactile sensitivity and masticatory performance are impaired in stroke patients.

Oro-facial impairment following stroke frequently involves reduced chewing performance, that is oral phase dysphagia. The aim was to investigate the sensitivity of oral tissues following stroke and its potential impact on masticatory function. Therefore, hospitalised post-stroke patients were recruited and compared to healthy controls. Outcome measures comprised masticatory performance employing a colour-mixing ability, that is a bolus-kneading test, maximum lip- and bite force and the one-point and two-point tactile thresholds. Food hoarding and prevalence of dry mouth were evaluated with ordinal scales. Twenty-seven stroke patients (age 64·3 ± 14·1 years) and 27 healthy controls (age 60·8 ± 14·3 years, P = 0·254) participated in this study. The groups had similar numbers of occluding units. Stroke patients reported more frequently dry mouth sensations and food hoarding. The intra-oral tactile sensitivity on the contra-lesional side was significantly lower in stroke patients compared to controls (0·0001 < P < 0·0002), and significant intra-group side differences were found only in the stroke group (0·0001 < P < 0·0010). For the lip, both sides were less sensitive in the stroke group compared with controls. The experiments confirmed lower masticatory performance and lip force in the stroke group, but the bite force was similar compared to healthy controls. Oral sensitivity was correlated with masticatory performance when a global correlation model was applied. A stroke may affect the sensitivity of the intra-oral tissues contra-lesionally, thus potentially affecting chewing function. Rehabilitation should therefore not only focus on motor impairment, but equally stimulate the sensitivity of the oral tissues, employing dry ice application or similar specific treatments.

Qualities of a French version of the Wolf Motor Function Test: a multicenter study.

INTRODUCTION: There are currently a small number of standardized tools in French that measure and compare the effect of constraint-induced movement therapy, or other recent therapies promoting motor recovery OBJECTIVE: To create a French version of the Wolf Motor Function Test (WMFT) and assess its reliability, minimal detectable change, and criterion validity. METHOD: Prospective multicenter repeated-measure design with 44 patients with post stroke hemiparesis. A French Version of the WMFT was created; it was then assessed against the Fugl Meyer Assessment-Upper Extremity (French version) to establish its reliability, the minimal detectable change and its validity. RESULTS: Inter-rater reliability was very good. Reproducibility of the scores was good. Cronbach α coefficients showed adequate internal consistency. The minimal detectable change (MDC95%) for functional ability scores was below 10% of the highest possible score; the MDC95% for performance time was very high at more than 90 seconds. Criterion validity was good. CONCLUSION: The French version of the WMFT is reliable and valid. The test shows promise for use as an objective outcome measure for people post stroke in French speaking countries.

[Functional weakness of movement]. / Trouble du mouvement d'origine fonctionnelle.

The diagnosis of functional paresis is evoked when a patient presents with symptoms and signs incompatible with current anatomical and physiological knowledge. A broad assessment, including imaging and motor evoked potentials at rest, remains necessary; the rate of false diagnosis being estimated at 4%. The mechanisms of hysteria remain still dubious but various studies suggest that functional paresis is different from simulation by conscious, voluntary inhibition. The long-term prognosis is bad. The treatment includes cognitive-behavioral therapy and rehabilitation to develop a positive attitude.

Quantitative assessment of facial muscle impairment in patients with hemispheric stroke.

Facial weakness is frequently observed in patients with hemispheric stroke. Most reports refer to qualitative assessment. The aim was to quantify the upper and lower facial muscle function in patients with hemispheric stroke. Three different facial expressions (forced smile, posed smile and maximum eyebrow lift) and facial rest position were mapped using a 3D video system. Twenty-seven patients with hemispheric stroke (PG) and 22 controls (CG) were recruited. Facial asymmetry was expressed as absolute side differences between four corresponding distances. In PG, a longer distance was found from inner canthus to oral commissure (dist1) on the impaired side in all investigated poses (PG non-affected-affected side: range of all poses 1·18 ± 4·45 to 1·80 ± 2·37 mm; CG right-left side: range -0·69 ± 1·55 to -0·43 ± 1·39 mm, Mann-Whitney tests: 0·0002 < P < 0·0423). In addition, the ratio of the impaired to the non-affected side was different in PG for dist1 in rest and eyebrow lift (Wilcoxon tests: 0·0011 < P < 0·0288). CG showed asymmetries in rest and forced smile (Wilcoxon tests: P = 0·0392 and P = 0·0424). Furthermore, dist1 in PG showed higher variances than in CG (F-tests: 0·0001 < P < 0·0445) except for the relative dist1 at rest (F-test: P = 0·0533). The distance between inner eyebrow corner and inner canthus showed no side difference in both groups during eyebrow lift (n.s.); nevertheless, two patients showed distinct asymmetries. The employed 3D video system proved sensitive in assessing facial muscle function. The results confirm and quantify that the lower facial muscles are more affected by hemispheric stroke than the upper ones and show that the measured distances were more variable in post-stroke patients than in control subjects.

Masticatory function and bite force in stroke patients.

Orofacial functions are frequently affected by stroke, but little is known on the nature and extent of the impairment of mastication, which is investigated in this observational study. Thirty-one stroke patients, aged 69.0 ± 12.7 yrs, presenting with a hemi-syndrome with facial palsy, were recruited. Chewing efficiency, maximum bite and restraining lip forces were tested. Stroke severity (National Institutes of Health Stroke Scale) and dental state were recorded. The control group was similar in age, gender, and dental state (n = 24). The chewing efficiency was significantly lower in the stroke group (p ≤ 0.0001) and was related to both the dental state and the lip forces measured with small and medium-sized labial plates. The maximum bite force proved to be not significantly different between sides or groups (n.s.), whereas lip force was significantly lower in the stroke group (p ≤ 0.05). Chewing efficiency is severely affected by stroke; thus, rehabilitation protocols should aim to restore the strength and co-ordination of the orofacial muscles.

Carotid artery calcification in ischemic stroke patients detected in standard dental panoramic radiographs - a preliminary study.

PURPOSE: Examine the prevalence of carotid artery calcifications in standard dental panoramic radiographs (OPT), their association to gender, medical history and oral status. Assess the predictive value of a dental OPT in early diagnosis of carotid artery calcifications. MATERIAL AND METHODS: Fourteen patients admitted to Geneva University Hospital for recent ischemic stroke and stenosis of the carotid artery confirmed by Duplex sonography. All OPTs were digitised and subsequently assessed independently by two operators. RESULTS: From 21 carotid artery calcifications detected with Doppler sonography 15 were visible on the corresponding OPT, most of them on the right side (n=11). No correlation was found between the side of calcification and cerebral lesion. Hypertension and periodontal disease were the most prevalent cardiovascular risk factors. CONCLUSIONS: Dentists who either detect carotid artery calcifications in OPTs or see patients with severe periodontitis should consider a prophylactic specialist examination.

Masseter muscle thickness in hospitalised stroke patients.

The aim of the study was to investigate the thickness of the masseter muscles in stroke patients when compared to a control group (CG). Hospitalised stroke patients (18 men, 13 women; age 69.0 +/- 12.7 years) were compared to a CG (13 men, 11 women; age 68.8 +/- 10.8 years) composed to correspond to in age, gender and dental state. The thickness of the masseter muscle was recorded by means of a real-time ultrasound scanner on both sides, twice under contraction and twice in relaxed condition. In the stroke patients, the thickness of the masseter muscle of the affected side (aff) was smaller than the one of the non-affected side (non-aff) both, under contraction (aff 13.1 +/- 2.4 mm; non-aff 13.8 +/- 2.3 mm, P

[Constraint-induced movement therapy in neurological rehabilitation: which modality to choose? Our experience in rehabilitation in Geneva]. / La thérapie par contrainte en rééducation neurologique: quelles modalités choisir? Notre expérience dans le service de neurorééducation à Genève.

OBJECTIVE: The purpose of constraint-induced movement therapy (CIMT) is to stimulate the use of the affected upper arm following stroke and to improve the integration of the arm in activities of daily living. CIMT consists of restraining the unaffected arm to limit its use, combined with a training program based on the shaping principle. We aimed to explore how this method can be used in practice by studying 4 patients after stroke. METHOD: We investigated 4 patients, 2 with chronic disability (10 and 17 months after the stroke), and 2 with subacute disability (1 month after the stroke). Patients underwent 3 weeks of treatment, with evaluations before, immediately after, 3 months and 1 year after the training. The following scales were used: Wolf Motor Function Test (WFMT), Fugl-Meyer Assessment (FMA), and motor activity log (MAL). RESULTS: Four patients showed enhanced function (improved WFMT and FMA scores) at 3 months and 3 patients at one year and better use of the paretic limb in daily activities (MAL score). Two patients in the subacute phase showed better speed of movement (WFMT score). CONCLUSION: The efficacy of CIMT seems to be confirmed by the literature and our observations. It is superior to the usual treatment but concerns only a few patients. The scheme of treatment is still not clear, but many studies recommend the use of a glove 90% of the day for 2 or 3 weeks, with 3 to 6 hours per day of intensive therapy.

Paradoxical switching to a barely-mastered second language by an aphasic patient.

Polyglot speakers who become aphasics are not necessarily affected to the same extent in each language. In some cases there is a mixing of the different languages or a switching between languages and in very rare cases the switch is to the language seldom if ever used in everyday live. We report a French-speaking aphasic, who switched paradoxically from his mother tongue (French) to a second language (German) which he had learned at school but barely mastered and hardly ever spoke, and kept using German most of the time. We tried to understand the mechanism responsible for that phenomenon by reviewing the actual hypothesis of multi-language organization. We concluded, in line with previous reports, that our case used his metalinguistic knowledge to compensate for his inability to access his linguistic skills.

[Ischemic, an uncommon complication of Biermer disease (pernicious anemia)]. / L'accident ischémique cérébral, une complication rare de la maladie de Biermer.

INTRODUCTION: Stroke in a young adult justifies an extensive etiologic workup. OBSERVATION: We present a 44-year-old women victim of a frontal ischemic stroke. Extensive evaluation was normal, except for high plasma level of homocysteine in the context of pernicious anemia, otherwise asymptomatic. DISCUSSION: Hyperhomocysteinemia is a known marker, and probably risk factor for stroke, fostering atherosclerosis and thrombosis. It can be found among individuals suffering from homocystinuria, in individuals homozygous for the MHTFR T allele but also when there is deficiency of vitamin B12 or folic acid. Although it is very seldom ascribed, pernicious anemia would be a cause of stroke, possibly though hyperhomocysteinemia.

Intracranial arterial and arteriovenous malformations presenting with infarction. Lausanne Stroke Registry study.

Cerebral aneurysms and arteriovenous malformations (AVMs) are well-known sources of intracranial hemorrhage, but can also manifest as other clinical symptoms or remain clinically asymptomatic. The aim was to document and analyze cases of aneurysm or AVM with brain infarction. Survey on 4804 stroke patients treated at the Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland between 1978 and 2000 using the Lausanne Stroke Registry. Twenty patients presented with cerebral aneurysm and 21 with cerebral AVM. Hemorrhage was present in 100% of the AVM and in 75% of the aneurysm patients; in one (5%) of the remaining aneurysm patients, aneurysm and infarction were located in different territories. Infarction associated with Sylvian artery aneurysm was found in three (15%), vertebrobasilar ischemia because of fusiform left vertebral artery aneurysm in one (5%), and dural fistula draining to the distal transversal and left sigmoid sinus associated with a stroke in the territory of the left anterior inferior cerebellar artery in one patient. Ischemic stroke is infrequent, but important, complication in unruptured intracranial aneurysms and AVMs. The early recognition and therapy of these vascular malformations in selected patients can avoid a major neurological deficit or death caused by their rupture.