Mobility and muscle strength contralateral to hemiplegia from stroke: benefit from self-training with family support.

OBJECTIVE: To determine whether patient exercise with the support of family members maximizes mobility and improves muscle strength in the nonparetic lower limb after stroke. DESIGN: Comparison of improvement at 2 wk between conventional exercise sessions and a program also including the participation of family members. Subjects were 60 patients rendered nonambulatory by severe hemiparesis from their first stroke. Of these, 42 had family members participating in their therapy. Lower limb strength was measured on the nonparetic side using an isokinetic machine. Mobility status was assessed using the Rivermead Mobility Index. Patients were evaluated at the first inpatient gym session and again at 1 and 2 wk. RESULTS: At the first evaluation, lower limb strength and the Rivermead Mobility Index score did not differ between the two groups. Reevaluations were conducted at 1 and 2 wk after the first evaluation. Patients' strength and mobility improved more when family members participated. CONCLUSION: Family participation is an important contributor to stroke rehabilitation.

[A case of amnesia caused by a subcortical hematoma in the left retrosplenial region].

A 54-year-old right-handed woman suffered transient aphasia and persistent amnesia caused by a subcortical hematoma in the left occipital lobe. She appeared to have aphasia, although it disappeared within 3 weeks. It is noteworthy that she had a lesion in the left retrosplenial region but exhibited both verbal and non-verbal memory impairment. However, her intelligence, remote memory and digit span were normal. She had no topographic disturbance. Computed tomography and magnetic resonance imaging revealed a subcortical hematoma in the left occipital lobe including the retrosplenial region. Single photon emission CT showed a low perfusion area in the retrosplenial region and in the left thalamus. We concluded that the retrosplenial amnesia might be caused by the interruption of hippocampal input into the anterior thalamus.

Unilateral spatial neglect in patients with cerebral hemorrhage: the relationship between hematoma volume and prognosis.

We examined patients with cerebral hemorrhage to determine the correlations between unilateral spatial neglect (USN) and neurological deficits, the site of lesions, and performance on activities of daily living (ADL) tests at discharge. Thirty-two right-handed patients with right hypertensive intracerebral hemorrhage (putamen 16, thalamus 16) were examined for neurological and neuropsychological deficits in addition to USN, and they received CT scans. USN was revealed in 26 of the patients (81.3%), of which 13 cases were putaminal hemorrhage and the other 13 were thalamic hemorrhage. The 32 patients were subdivided into three groups: those without USN, those with transient USN, and those with persistent USN. Among the patients with putaminal hemorrhage, the presence and persistence of USN seemed to be largely dependent on the size of the hematoma. Of the 7 cases with hematoma volume greater than 40ml, 4 revealed persistent USN; the other 3 cases, each of whom was under 50 years of age, showed transient USN. No cases with hematoma smaller than 20ml revealed USN. Among the thalamic hemorrhages, the size of the hematoma had no relation to the presence of USN. All 13 cases of USN caused by thalamic hemorrhage were transient. Among all the patients, those with USN showed lower ADL scores on admission than patients without USN. At discharge, ADL among patients with transient USN had improved more than the ADL of patients without USN. Therefore, we suspected that improvement in ADL might be affected by USN.

Medial medullary infarction: a role of diffusion-weighted magnetic resonance imaging for stroke rehabilitation.

We report a patient with medial medullary infarction who could be diagnosed in an early stage, and we discuss the role of diffusion-weighted magnetic resonance imaging (MRI) for stroke rehabilitation. In the case of our patient, the infarction was difficult to diagnose because the patient had atypical features and a past history of head injury. Nonetheless, we could diagnose the medial medullary infarction easily using diffusion MRI within several hours of onset. Then, a rehabilitation program was started the day after onset. We believe that diffusion MRI can be used as a useful method for very early stage diagnosis and to execute rehabilitation for early stroke patients.

Relationships between event-related potentials (P300) and activities of daily living in Parkinson's disease.

The correlation between event-related potentials (P300) and activities of daily living was studied in Parkinson's disease. The P300 of 30 patients with Parkinson's disease and 118 normal subjects were recorded. All patients were evaluated by the Mini-Mental State, Kana-hiroi Test, word fluency, Raven's Coloured Progressive Matrices, Osaka Memory Scale, revised Wechsler Adult Intelligence Scale, self-rating depression scale, state-trait anxiety inventory, and Functional Independence Measure. Eight patients showed prolonged P300 latencies. P300 latency showed relationships to the Mini-Mental State (p < 0.05) and cognitive items of the Functional Independence Measure (p < 0.05). P300 amplitude showed a relationship to performance IQ (p < 0.005), Raven's Coloured Progressive Matrices (p < 0.01) and motor items of the Functional Independence Measure (p < 0.05). It was concluded that P300 should be useful in predicting difficulties with activities of daily living in patients with Parkinson's disease.

Quantitative assessment of impairment in constructional ability by cube copying in patients with aphasia.

Constructional apraxia was evaluated in patients with aphasia using a cube-copying task. It was assessed whether quantitative assessment of cube copying could be used to estimate the performance intelligence quotient (IQ) according to neuropsychological tests. Abnormality in the cube-copying test was observed in 42 of 46 patients (91.3%). Performance according to Raven's coloured progressive matrices and the revised Wechshler adult intelligence scale (WAIS-R) in patients with poor cube copying was significantly lower than in the other four patients. Numbers of the connections completed and plane-orientation errors made in the cube-copying test were significantly correlated with performance IQ on the WAIS-R, correlating particularly with block design, digit symbol, and object assembly in performance IQ subtests. The quantitatively scored cube-copying test, then, can roughly predict non-verbal IQ in patients with aphasia.

Transient aphasia and persistent amnesia after surgery for internal carotid artery--posterior communicating artery aneurysm.

We report a case of transient aphasia and persistent amnesia after clipping of a ruptured cerebral aneurysm to treat a subarachnoid hemorrhage. Postoperatively, aphasia was identified and magnetic resonance imaging (MRI) showed an abnormal intensity area in the left anterior thalamus. Single photon emission computed tomography (SPECT) revealed a wider area of low perfusion surrounding the left thalamus and left frontotemporal lobe than that shown by the MRI. His aphasia resolved over the subsequent 12-week period. He was left with an isolated disturbance of memory; in the absence of any dementia, aphasia or disturbance of consciousness, his condition was classified as one of amnesia. SPECT 14 weeks after admission revealed an area of low perfusion limited to the left thalamus. These findings suggest that the persistence of amnesia in this case was caused by the infarction of the mammillothalamic tract, and the recovery from aphasia may have resulted from the disappearance of surrounding edema.