ABSTRACT
Ambient echolalia is a rare condition with few reported cases. We report the case of a 20-year-old man with a germinoma around the bilateral ventriculus lateralis who exhibited ambient echolalia. Clinical features included instinctive grasp reaction and compulsive manipulation of tools in his right hand. Speech or mental deterioration has been cited as a cause of ambient echolalia, but neither dementia nor aphasia was present. We propose that ambient echolalia in our case could be interpreted as a disinhibition of pre-existing essentially intact motor subroutines due to damage of the medial frontal lobe.
Subject(s)
Brain Neoplasms/complications , Echolalia/etiology , Echolalia/psychology , Germinoma/complications , Brain Neoplasms/psychology , Brain Neoplasms/therapy , Combined Modality Therapy , Frontal Lobe/pathology , Germinoma/psychology , Germinoma/therapy , Humans , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Neurosurgical Procedures , Young AdultABSTRACT
We reported two patients with unilateral lateral medullary infarction involving severe, long-term respiratory failure. The first patient is an 86-year-old man presenting with gait disturbance, hoarseness and dysphagia. A right lateral medullary infarction was revealed by brain MRI. On the fifth hospitalized day, acute respiratory failure occurred. His condition failed to recover, and he was still attached to a ventilator 10 months after the onset. The second patient is an 83-year-old woman mainly presenting with dysphagia. A tiny infarction in the right lateral medulla was revealed by brain MRI. On the third day after the onset, acute respiratory failure occurred, which was not changed even at 8 months later. Although the symptoms and the lesion in the medulla were quite different between two patients, dysphagia and respiratory failure occurred in both patients. Therefore, it is postulated that the lesion that causes dyspnea may be approximate to the lesion that causes dysphagia. Many previously reported cases presenting respiratory failure seemed to suffer swallowing difficulty as well. We conclude that elderly patients suffering from unilateral lateral medullary infarction with dysphagia can present respiratory failure a few days after the onset, demonstrating the need to observe them under intensive attention.
Subject(s)
Cerebral Infarction/complications , Medulla Oblongata/blood supply , Respiratory Insufficiency/etiology , Aged, 80 and over , Cerebral Infarction/diagnosis , Deglutition Disorders/etiology , Female , Humans , Magnetic Resonance Imaging , Male , Respiration, Artificial , Respiratory Insufficiency/therapy , TracheotomyABSTRACT
Conduction velocities (CVs) in two nociceptive afferents were estimated to clarify the mechanism of pain transmission. Late and ultra-late laser evoked potentials (LEPs) were recorded by stimulating Adelta- and C-nociceptive nerve endings at different skin sites (the hand, foot, and skin overlying the 7th cervical and 12th thoracic vertebrae), by which data CVs of the arm (CVA), leg (CVL), and spinothalamic tract (CVSTT) were estimated. In late LEPs, Adelta-CVA and Adelta-CVL respectively were between 6.7 and 23.7 (mean +/- SD, 12.8 +/- 5.2) m/s, and 9.0 and 26.7 (17.2 +/- 5.6) m/s. Adelta-CVSTT was between 4.1 and 22.1 m/s (10.6 +/- 5.8). In ultra-late LEPs, C-CVA and C-CVL respectively varied between 1.0 and 2.1 (mean +/- SD, 1.5 +/- 0.3) m/s, and 1.0 and 1.9 (1.4 +/- 0.2) m/s. C-CVSTT was between 1.0 and 3.9 (1.8 +/- 0.8) m/s. No significant difference was found among CVA, CVL, and CVSTT values calculated from late or ultra-late LEP latencies. Nociceptive signals of the primary Adelta- and C-afferents therefore may be conveyed separately by myelinated (Adelta-) and unmyelinated (C) axons through peripheral nerves and spinal cord.
