[Sinking skin flap syndrome]. / Sindrome del colgajo hundido.

INTRODUCTION: The sinking skin flap syndrome is a complication of decompressive craniectomies. It is of relevance not only due to its frequency, it is often underdiagnosed, but also because of the possibility of reversing the symptoms with the proper treatment. CASE REPORT: A 53-year-old female sustained a severe head injury. The initial Glasgow Coma Scale was 6T. The CT scan showed a severe traumatic injury in the left temporal lobe that required a decompressive craniectomy. After surgery the patient developed aphasia and right hemiparesis but progressively improved. Four months after surgery, however, she presented neurological worsening. An MRI showed skin retraction with a mass effect on the brain parenchyma at the craniectomy defect. A cranioplasty was performed and the patient progressively recovered neurologically. CONCLUSIONS: The symptoms of sinking skin flap are headache, dizziness, inappropriate behaviour, neurological functional impairment and/or seizures. The symptoms worsen with the Valsalva manoeuvres and with changes in position. Typically, symptoms 3 to 5 months to appear. Theories to explain these symptoms include a direct atmospheric pressure effect, brain blood flow changes, alteration in cerebrospinal fluid dynamics and metabolic disturbances. Diagnosis is performed through clinical observation but imaging studies are recommended to confirm the diagnosis. The treatment of choice is a cranioplasty. Prognosis is excellent and almost all patients recover completely.

Differential recovery in naming in bilingual aphasics.

Language performance in a sample of 30 Catalan-Spanish bilingual aphasics was studied using three nominal tasks (naming, pointing, and translation). We compared performance between the two languages before and after therapy and also compared the improvements made in each language. Therapy was carried out in only one language, namely Catalan. Significant differences between the two languages were initially seen in the naming and translation tasks while after treatment significant differences were observed in the naming and pointing tasks. Analysis of covariance was carried out to control the influence of the initial performance on improvements. Performance in the naming task improved more in the treated language (Catalan) than in the nontreated language. We conclude that both differential impairment and recovery of languages in bilingual aphasics is seen not only in rare cases but also in studies of larger samples.

[Introduction to neuropsycholinguistics]. / Introducción a la neuropsicolinguística.

The authors summed up the evolution of the current neuropsicolinguistics and of its origins. They proposed a general definition of the aphasic disorders in relation to the psycholinguists capacities involved. The paper finish with a brief reference to the variety of types of the aphasics disorders according with its fluent or non-fluent caracter.