Nonfluent Aphasia Research Articles (Page 1)

Multiple myeloma (MM), ranking as the second most prevalent hematologic malignancy. Despite prolonged survival in MM due to novel therapies, infections remain a leading cause of mortality. While bacterial pneumonias and viral reactivations are well-documented, Listeria monocytogenes (L monocytogenes) (a rare but aggressive pathogen) is underrecognized in MM. In this report, we report a 60-year-old male patient with newly diagnosed IgA-λ MM (Durie-Salmon stage IIIA, ISS stage III with 1q21 amplification) who developed high-grade fever (39.8 °C) and expressive aphasia during the second cycle of bortezomib-lenalidomide-dexamethasone induction therapy. Initial workup revealed neutrophilia (absolute neutrophil count 1.94 × 10⁹/L) with elevated inflammatory markers (C-reactive protein 118.14 mg/L). Cerebrospinal fluid analysis showed albuminocytologic dissociation (protein 1116.3 mg/L, glucose 1.77 mmol/L, chloride 114.75 mmol/L) without positive cultures. Contrast-enhanced brain MRI demonstrated neither abscess formation nor acute ischemia. Repeated blood cultures drawn at fever onset, L monocytogenes bacteremia was confirmed 48 hours after-afebrile through blood culture. The patient has been diagnosed MM with bacteremia and meningitis caused by L monocytogenes infection. Empiric meropenem was initiated promptly, achieving defervescence within 72 hours. Upon availability of antimicrobial susceptibility testing (intravenous penicillin G 8 million units every 8 hours), with documented blood culture clearance at 72 hours. On the second day of medication, the patient's aphasia symptoms were resolved, the fever subsided on the 3rd day, and the blood culture turned negative on the 10th day. The patient completed a 21-day targeted antibiotic course without neurologic sequelae and was discharged with planned resumption of anti-myeloma therapy. This case underscores the need for early empiric coverage for Listeria in MM patients with unexplained fever or neurological symptoms, particularly given its high mortality in immunocompromised hosts.

Background: Patent foramen ovale (PFO) is a recognized contributor to embolic stroke, especially in hypercoagulable states (HCSs). However, patients with HCSs, including malignancy, were excluded from major PFO closure trials, creating a significant evidence gap. Objectives: This narrative review examines the role of PFO closure in secondary stroke prevention among patients with HCSs, including malignancy. We highlight key studies and current evidence in this understudied population. Methods: A systematic search of PubMed was conducted using pertinent MeSH terms. Due to limited data, a narrative synthesis of the literature was performed. Case Presentation and Narrative Review of Literature: A 43-year-old lady with a history of metastatic breast cancer and recent bilateral pulmonary emboli on anticoagulation (AC), presented with expressive aphasia. MRI brain confirmed a Broca-area infarct. Biopsy of an expansile pelvic mass yielded a diagnosis of ovarian mucinous cystadenocarcinoma. TEE demonstrated a PFO; an embolic stroke driven by hypercoagulability of malignancy was diagnosed. PFO closure was offered for secondary stroke prevention after risk-benefit discussion, as opposed to AC alone. While early trials (CLOSURE I, PC) showed no benefit of closure, subsequent studies (RESPECT, REDUCE, DEFENSE-PFO) favored it in selected patients, but notably, these trials excluded patients with HCSs and malignancy. The benefit of PFO closure in this population thus comes largely from observational data. Abrahamyan et al. found that PFO closure could be safely offered in patients with thrombophilia to prevent recurrent stroke. Liu et al., in their prospective study, noted that among patients with cryptogenic stroke and thrombophilia, PFO closure lowered the risk of recurrence. Similarly, a retrospective study from Greece found benefit from PFO closure in this population. Buber et al. found that among patients with HCSs and stroke, PFO closure offered a five-fold risk reduction from future CVA/TIA. The Society for Cardiovascular Angiography and Interventions (SCAI) guidelines recommend PFO closure in patients with thrombophilia for secondary stroke prevention (conditional recommendation- low certainty of evidence). Conclusions: Data on PFO closure for secondary stroke prevention in HCSs and malignancy are scant, necessitating individualized decision making. Current evidence supports PFO closure, but future studies are needed specifically in this vulnerable population.

Introduction: Cardiac tamponade typically results from pericardial fluid accumulation that impairs diastolic filling. Rarely, extracardiac structures can cause similar physiologic compromise. We report a case of extracardiac tamponade caused by a large paraesophageal hernia, emphasizing the need to maintain a broad differential diagnosis of causes in patients with hemodynamic instability. Case: An 87-year-old male with stage IV chronic kidney disease, prior stroke with expressive aphasia, paroxysmal atrial fibrillation, and poor functional status became hypoxic during an outpatient echocardiogram. On arrival to the ED, he was alert, oriented, and denied chest pain, palpitations, or dyspnea. Vitals showed BP 125/61 mmHg and oxygen saturation of 88% on room air, improved with 2L nasal cannula. ECG revealed a normal sinus rhythm with first-degree AV block. Chest CT showed a large paraesophageal hernia, fluid-filled esophagus, and bilateral pleural effusions (Figure 1). Transthoracic echocardiogram (TTE) showed preserved LV ejection fraction but significant diastolic compression of the inferior and inferolateral walls, with increased mitral and tricuspid inflow variability—findings consistent with tamponade physiology (Figure 2). Notably, no pericardial effusion was seen. He was deemed too high risk for any surgical or endoscopic intervention. A nasogastric (NG) tube was placed, and 500 cc of gastric contents were aspirated. Repeat TTE still showed tamponade physiology, prompting continued NG decompression for 48 hours. Follow-up imaging demonstrated resolution of LV compression and improvement in inflow variability (Figure 3). Discussion: While cardiac tamponade is most often due to pericardial effusion, external cardiac compression from adjacent thoracic structures can produce a similar pathophysiology. Large hernias can compress cardiac structures, particularly the posterior LV, leading to hemodynamic compromise. This case emphasizes the importance of considering extracardiac causes when tamponade features are present without pericardial effusion. Extracardiac tamponade should be suspected in patients with tamponade physiology and no effusion. Cross-sectional imaging and interdisciplinary management are essential. Conservative decompression may be effective in high-risk patients.

A 27-year-old woman on 4th postpartum day presented to ED with fatigue, dysphagia, and chest tightness. Appeared anxious and had sinus tachycardia. Labs revealed leukocytosis, elevated hsTrop, and pro-BNP. TTE demonstrated LV systolic dysfunction (EF 35%), with basal hypokinesis and preserved apical function, raising suspicion for reverse Takotsubo cardiomyopathy. Workup for dysphagia included brain MRI, which revealed a CLIPPERS-like brainstem lesion. She was treated with high-dose IV steroids, DAPT for 21 days, and GDMT. Readmitted within days with new-onset expressive aphasia and right lower extremity weakness. MRI showed an acute infarct in the left anterior cerebral artery (ACA) territory. Cerebral angiography confirmed moderate to severe vasculitis and vasospasm of the bilateral ACA and left MCA. Steroids were escalated, and rituximab was initiated for presumed steroid-refractory postpartum vasculitis. Immunosuppressive therapy included prednisone and mycophenolate mofetil. Further testing confirmed VZV CNS vasculitis (positive VZV IgM, oligoclonal bands, and angiographic vasculitis); valacyclovir was later added. Repeat echocardiogram two weeks later showed EF normalization to 55–60% with no regional wall motion abnormalities, confirming transient rTTC. This case illustrates an unusual neurocardial interaction: VZV-induced CNS vasculitis triggered reverse Takotsubo cardiomyopathy in a postpartum woman. The catecholaminergic surge and neuroinflammatory milieu a/w CNS involvement likely contributed to myocardial stunning. The postpartum period may further predispose to immune dysregulation, explaining the fulminant course of vasculitis. rTTC is classically associated with neurological insults like subarachnoid hemorrhage or seizures, but to our knowledge, this is the first reported case linking VZV vasculitis to rTTC . This emphasizes the need to consider stress cardiomyopathy variants in postpartum patients presenting with cardiac and neurological symptoms and supports early echocardiography and CNS imaging in such scenarios. We report a rare and complex case of reverse Takotsubo cardiomyopathy secondary to VZV-induced CNS vasculitis in the postpartum period. This case highlights the critical interplay between the central nervous system and cardiac function, the importance of early multidisciplinary involvement, and the potential reversibility of both cardiac and neurological complications with timely immunosuppressive and antiviral therapy.

Description of Case: A 47-year-old female with history of thrombophilia (PAI-1 4G/4G genotype), Barlow syndrome with native leaflet repair then mechanical mitral valve (MV) replacement on warfarin, and previous stroke due to MV thromboembolism, presented with more than 24-hour onset of expressive aphasia. CT head showed showed acute ischemic stroke (AIS) in left parietal lobe with left middle cerebral artery (MCA) distal occlusion on CTA-head despite warfarin use and therapeutic INR-2.5. Within hours of admission, she had neurological deterioration and brain MRI demonstrated new left frontal-temporal intracranial hemorrhage (ICH) with cerebral herniation. She emergently received 4F-PCC/vitamin K, underwent decompression craniectomy. TTE showed MV severe stenosis. TEE (Figure 1) confirmed MV thrombus, similar embolic mechanism to prior AIS. To balance the concomitant high risks of strokes given mechanical MV thrombus requiring uninterrupted anticoagulation (AC) and ICH recurrence with AC, she was started on low-dose heparin infusion without bolus day 8. Transcranial Doppler (TCD) (Figure 2) was utilized to determine risk of cerebral embolization from MV thrombus via detection of microemboli or high-intensity transient signals (HITS) within bilateral MCA. Although patient anticoagulated with heparin, we detected 16 HITS in 15 mins of embolic monitoring suggesting high risk of recurrent ischemic stroke. AC was switched to enoxaparin at 1mg/kg twice daily and repeated TCD-emboli on day 15 showed continued AIS risk with 11 HITS even with a therapeutic anti-Xa level of 0.7 (goal 0.6-1.0). Enoxaparin dosage increased guided by emboli monitoring until HITS resolved. She was discharged to stroke rehab with plan to bridge to warfarin (INR goal 3.5-4.0) after 4 week. At one-month follow-up, she remained on warfarin 10mg daily with therapeutic INR and free of recurrent AIS or ICH. Discussion: Microembolic signals detected on TCD can be used as biomarkers to predict stroke risk and guide therapeutic interventions. Our patient was at risk of further ICH after decompressive hemicraniectomy but without anticoagulation she had high risk of embolic stroke from mechanical MV thrombus. TCD emboli monitoring played a pivotal role in guiding the timing of AC initiation and determining the therapeutic dose to reduce risk of both recurrent emboli and hemorrhagic complications.

Recursive self-feedback enables target language production in aphasia with pathological language mixing.

Dural arteriovenous fistulas (dAVFs) are uncommon intracranial vascular shunts that typically cause hemorrhage when retrograde cortical venous drainage and diffuse venous hypertension are present. Venous aneurysms are usually considered a sequela of sustained venous hypertension; however, localized focal hemodynamic stress may also contribute to aneurysm formation and rupture. We report a rare case of a 51-year-old woman who presented with acute expressive aphasia and dense right hemiparesis. Imaging revealed a large left temporoparietal intracerebral hemorrhage with subarachnoid extension. Digital subtraction angiography demonstrated a left temporal dAVF supplied by the middle meningeal artery and draining via the veins of Trolard and Labbé into the superior sagittal sinus. A discrete saccular venous aneurysm was identified at a sharply angulated and stenotic draining segment, suggesting localized venous hypertension without diffuse angiographic congestion. Transarterial embolization using Onyx-18 achieved complete obliteration of the fistula and aneurysm. At one-month follow-up, the patient showed complete recovery of aphasia and marked motor improvement. This case illustrates that focal venous hypertension, even without diffuse angiographic congestion, can result in aneurysm formation and rupture. Early angiographic assessment and endovascular intervention remain critical for favorable outcomes.

ABSTRACT Background People with aphasia (PWA) often struggle to determine who/what pronouns refer to. However, spontaneous speech studies on non-fluent PWA have revealed a disparity: one cluster of PWA tends to omit pronouns, while another cluster tends to overuse them. This study improves our current knowledge of pronoun processing by presenting how aphasia impacts pronoun production in Turkish. Aims This study addresses three questions: (i) whether Turkish-speaking PWA show impairments in producing pronouns in spontaneous speech, either through omission or overproduction; (ii) whether their production of personal pronouns is selectively affected; and (iii) whether theyexhibit difficulties in producing deictic and/or non-personal pronominal elements, including demonstratives, indefinites, and possessives. Methods & Procedures Spontaneous speech samples from 10 PWA speaking Turkish and 10 matched healthy controls were analysed. Three groups of pronoun variables were quantified: (i) general characteristics of pronoun uses including total number of pronominal elements, and pronoun-to-noun ratios, (ii) total and null personal pronouns in subject and object positions, and (iii) other types of pronouns including demonstrative, indefinite, and possessive pronouns. Outcomes & Results The Turkish-speaking PWA were above the control norms in total number of pronominal elements, and pronoun-to-noun and pronoun-to-word ratios, but they showed reduced lexical diversity in noun usage. They produced more first-person (deictic) than third person (anaphoric) pronouns while this difference was not significant in the controls. The PWA exhibit overuses in null subjects and objects, demonstratives and indefinite pronouns. Conclusions Turkish-speaking PWA overproduce pronouns; however, this overuse does not represent a uniform pattern. Overuses caused mostly by deictic elements such as demonstratives and indefinite pronouns, in the context of reduced lexical diversity in nouns. While the overuse of pronouns likely reflects a communicative strategy, the extent and nature of this strategy seem to vary across individuals.

Time reference is often impaired in people with aphasia (PWA), but most research has focused on verb tense production in sentence-level tasks. Few studies have examined how PWA manage time reference in discourse, particularly in fluent aphasia. This study thus investigated how people with fluent and nonfluent aphasia produce verb tenses in discourse and how task type influences performance. Additionally, we explored linguistic patterns associated with time reference in PWA, namely, reduced verb diversity and increased use of temporal adverbs. We conducted a cross-sectional observational study with 21 PWA (11 nonfluent, 10 fluent) and 21 healthy controls. Participants completed two discourse tasks: a sequential picture description (past, present, and future frameworks) and a semistandardized interview (past and future frameworks). Verb tense production, verb diversity, and temporal adverbs were analyzed using generalized linear mixed models. Both aphasia groups produced a comparable number of inflected verbs to control when controlling for word count, aligning with the expected temporal framework. Task effects were observed across all participants, with more present tense verbs in the interview and more future tense verbs in the picture description task, irrespective of the temporal framework. Regarding the linguistic patterns associated with time reference, individuals with nonfluent aphasia exhibited a trade-off effect in the past framework of the picture description task: higher verb diversity was associated with lower past-tense verb production. Conversely, individuals with fluent aphasia relied more on temporal adverbs. The study demonstrates that both fluent and nonfluent aphasia impact discourse-level time reference, each with distinct associated linguistic patterns. It also highlights the need for task-specific assessments in clinical practice. https://doi.org/10.23641/asha.30329683.

BACKGROUND. Statistics have recently shown a tendency towards an increase in the number of stroke patients, most often with consequences such as speech disorders, which occur in 30–40 % of the total number of patients, manifested by aphasia and dysarthria. In this regard, the urgent problem of gerontology is the recovery of speech in aphasia. The most common variants of aphasia that require the participation of a speech therapist include acoustic-gnostic, acoustic-mnestic, and semantic forms of it. Taking into account the age of the patients and concomitant diseases (chronic cerebral ischemia, hearing loss, impaired cognitive functions, decreased mood), most of them fail to achieve the desired positive correction results due to lack of motivation for rehabilitation.OBJECTIVE. The aim of the research was to study the results of speech therapy rehabilitation in elderly and senile patients who were in the gerontological center (GC) «Ekaterinodar».MATERIALS AND METHODS. Materials and methods. Since June 2024, a speech therapist has been employed at GC Ekaterinodar, who, in the direction of internists and/or geriatricians of the center, conducted a speech therapy consultation, which took into account the results of an initial examination by a medical psychologist to fill out a psychological passport indicating the cognitive and emotional sphere, the characteristics of socialization, and the character of the patient. A total of 15 patients (7 men, 8 women, average age (73.4 ± 2.3) years) with aphasia underwent corrective and rehabilitation work. In all cases, aphasia was a consequence of a stroke from 6 months to 10 years ago. The following types of aphasia were identified: gross sensorimotor (4 patients), acoustic-gnostic (3 patients), total (3 patients), acoustic-mnestic (4 patients) and afferent motor aphasia of moderate severity (1 patient). Different techniques developed by Russian scientists were used to correct aphasia (M. M. Shcherbakova, S. V. Kotov and others), an individual lesson plan was drawn up.Age-related memory changes and the level of education were taken into account in each individual case. In the acoustic-gnostic form, work was carried out with global reading, the selection of semantic distortions, and the subject relationship of the word. In this group of patients, such techniques as solving crosswords, selecting synonyms, antonyms for words, and retelling the text were used. The speech therapy correction plan for the semantic form of aphasia included the analysis of schematic pictures, and in the case of a mild disorder, the identification of cause–and-effect relationships, the selection of prepositions, the solution of logical problems, and the correction of grammatical errors. In the acoustic-mnestic form, the basis of classes was visual perception, which was supplemented, depending on the severity of the violations, by creating sentences from individual words, solving mathematical exercises, and identifying logical errors in the presented text. In addition, all patients underwent elements of creative therapy, speech therapy massage, articulatory gymnastics, classes with teachers and psychologists. Statistical data processing was carried out using nonparametric criteria.RESULTS. The results of the study. A total of 442 individual speech therapy sessions were conducted. Control studies have shown that after 3–6 months of individual speech therapy exercises combined with psychological exercises, all 15 patients showed positive dynamics of speech contact of varying degrees of severity against the background of an improvement in their psychological state.CONCLUSION. Conclusions. Speech therapy work to overcome aphasia in elderly and senile people in social entities in synergy with psychologists allows achieving positive results and increasing social adaptation.

BackgroundSince October 2023, the Gaza War has caused thousands to suffer from war-related traumatic brain injuries (TBIs) amid the collapse of Gaza’s healthcare system. Little is known about the epidemiology and outcomes of TBI in such severely resource-limited settings.MethodsWe conducted a prospective cohort study at the two largest neurosurgical centers in the southern Gaza Strip from July 15, 2024, to January 19, 2025. Patients with war-related TBI were enrolled consecutively and followed for 30 days after admission. Data were collected on demographics, clinical presentation, imaging findings, interventions, complications, and outcomes. The primary outcome was 30-day mortality, while secondary outcomes included the neurological status at discharge and complications.ResultsA total of 244 patients were included, with a median age of 21 years, and 74.5% were males. The 30-day mortality rate was 26.2%. Severe TBI (GCS ≤ 8) at admission was associated with a higher mortality compared to mild and moderate TBI (p < 0.001). Non-survivors had significantly higher rates of multilobar and bilateral injuries, subdural and intraventricular hemorrhages, midline shifts, and effaced basal cisterns. Among survivors (n = 180), 27.2% experienced neurological deficits at discharge, most commonly motor impairment and aphasia. Neurological deficits were linked to penetrating injuries, multilobar involvement, midline shifts, and ≥ 3 shrapnel fragments on imaging. Complication rates were generally low but higher among individuals with neurological impairments. Multivariate regression analysis showed that TBI severity (moderate: aRR = 7.05, 95% CI: 2.32–14.23; severe: aRR = 9.91, 95% CI: 4.56–18.64), older age (aRR = 1.02 per year, 95% CI: 1.01–1.03), brain matter extrusion (aRR = 2.24, 95% CI: 1.06–4.70), intraventricular hemorrhage (aRR = 2.38, 95% CI: 1.39–4.03), and subdural hemorrhage (aRR = 1.90, 95% CI: 1.30–4.03) were significant predictors of 30-day mortality.ConclusionIn this cohort of war-related TBI patients in Gaza, mortality was significantly linked to admission GCS, age, brain matter extrusion, IVH, and SDH. The study highlights how resource-limited, conflict-driven healthcare disruptions impact TBI outcomes and emphasizes the need to strengthen neurosurgical capacity, emergency response systems, and rehabilitation efforts in such environments.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13049-025-01477-1.

Unspoken art: progressive non-fluent aphasia in a painter.

Frontotemporal dementia (FTD) presents a complex spectrum of neurodegenerative disorders, encompassing distinct subtypes with varied clinical manifestations. This study investigates alterations in brain module organization associated with FTD subtypes using connectome analysis, aiming to identify potential biomarkers and enhance subtype prediction. Resting-state functional magnetic resonance imaging data were obtained from 41 individuals with behavioral variant frontotemporal dementia (BV-FTD), 32 with semantic variant frontotemporal dementia (SV-FTD), 28 with progressive non-fluent aphasia frontotemporal dementia (PNFA-FTD), and 94 healthy controls. Individual functional brain networks were constructed at the voxel level and binarized based on density thresholds. Modular segregation index (MSI) and participation coefficient (PC) were calculated to assess module integrity and identify regions with altered nodal properties. The relationship between modular measures and clinical scores was examined, and machine learning models were developed for subtype prediction. Both BV-FTD and SV-FTD groups exhibited decreased MSI in the subcortical module (SUB), default mode network (DMN), and ventral attention network (VAN) compared to healthy controls. Additionally, BV-FTD specifically displayed disrupted frontoparietal network (FPN) integrity compared to other FTD subtypes and controls. All FTD subtypes showed increased PC values in the insular region and reduced connections between the insular and VAN/FPN compared to controls. Moreover, significant associations between specific network alterations and clinical variables were observed. Machine learning models utilizing these matrices achieved high performance in differentiating FTD subtypes. This pilot study reveals diverse brain module organization across FTD subtypes, shedding light on both shared and distinct neurobiological underpinnings of the disorder.

Rationale:Fat embolism syndrome is a serious and potentially life-threatening complication associated with long bone fractures and orthopedic procedures. Cerebral fat embolism (CFE), a rare neurological manifestation of fat embolism syndrome, typically manifests with nonspecific encephalopathic symptoms. Isolated focal neurological deficits, such as aphasia, are highly uncommon and seldom reported. This case illustrates an atypical presentation of CFE characterized by acute, isolated aphasia to enhance clinical awareness and prompt recognition.Patient concerns:A 57-year-old male developed acute expressive aphasia 1 hour following intramedullary nailing of a tibial fracture, in the absence of respiratory distress, hemodynamic instability, or dermatologic abnormalities.Diagnoses:Brain magnetic resonance imaging revealed the characteristic “starfield” pattern, confirming the diagnosis of CFE based on clinical history and laboratory findings.Interventions:Management included comprehensive supportive care: supplemental oxygen, intravenous glucocorticoids, and subcutaneous low-molecular-weight heparin.Outcomes:By the fourth postoperative day, his condition had stabilized. His language function improved gradually over the following days, and he was discharged 1 week after surgery, able to produce short sentences with occasional pauses.Lessons:This case highlights that CFE can present with isolated aphasia. Early magnetic resonance imaging utilizing diffusion-weighted imaging is essential to confirm the diagnosis. A high clinical suspicion for CFE must be maintained in any patient exhibiting acute neurological deficits following orthopedic surgery to ensure timely recognition and intervention.

ObjectiveMotor aphasia is a common language disorder that significantly disrupts patients’ communication abilities and quality of life. Recent studies have shown that acupuncture treatment is effective for motor aphasia, but in clinical practice, the selection of acupuncture points for motor aphasia is diverse and lacks a unified standard. Therefore, by analyzing a range of clinical parameters encompassing multiple acupuncture points, we identified independent predictive factors for recovery from motor aphasia following acupuncture treatment.Materials and methodsThis retrospective case–control study included 144 patients with motor aphasia at Liaoning University of Traditional Chinese Medicine Affiliated Hospital (2019–2023). Propensity score matching (PSM) balanced baseline characteristics (age, gender, disease factors, comorbidities) using 1:1 nearest neighbor matching (caliper = 0.2 SD). LASSO, Random Survival Forest, and Gradient Boosting Machine algorithms selected 44 variables, and a multivariate Cox regression model assessed treatment outcomes.ResultsAfter PSM, baseline characteristics were balanced between the treatment group (tongue acupuncture, n = 40) and the control group (n = 40) (SMD < 0.1). Cross-analysis using LASSO, RSF, and GBM confirmed that age, time to rehabilitation start (TSR), and tongue acupuncture treatment are key predictive factors. Multivariate Cox regression analysis revealed that age ≥60 years (HR = 0.10, 95% CI: 0.02–0.50, p = 0.005) and TSR ≥ 12 days (HR = 0.41, 95% CI: 0.20–0.82, p = 0.031) are risk factors for recovery, while tongue acupuncture treatment (HR = 2.92, 95% CI: 1.29–6.62, p = 0.010) significantly improved treatment outcomes. Model performance was robust, with AUC values of 0.91 ± 0.07, 0.89 ± 0.08, and 0.89 ± 0.07 for LASSO, RSF, and GBM, respectively, and Cox model AUC of 0.88. Patients were categorized into low-risk (age <60 years, TSR < 12 days, receiving tongue acupuncture) and high-risk groups, with significant differences observed (HR = 0.31, 95% CI: 0.16–0.61, p < 0.001).ConclusionTongue acupuncture enhances motor aphasia recovery, while older age and delayed rehabilitation hinder it. PSM and machine learning ensured robust predictions, supporting early tongue acupuncture. Future multicenter studies will further validate these findings.

Abstract Objective We describe a peculiar combination of West Nile virus (WNV) and SARS-CoV-2 infection, suggesting crucial clinical implications for diagnosis and management. Case report We present a case of a 57-year-old woman with a past medical history of end-stage renal disease (ESRD), on chronic hemodialysis, and arterial hypertension. She was admitted to the hospital for a 5-day history of fever, headache, vomiting, psychomotor slowing, a diffuse tremor on the four limbs, and diarrhea. Evaluation revealed the presence of neutrophilic leukocytosis, hemoglobin level of 10.5g/dL, elevated C-reactive protein (60 mg/L), serum creatinine of 13.4 mg/dL with hyperkaliemia. Neurologic examination described the following findings: neck stiffness, confusion with motor aphasia, bradylalia, bradypsychia, global hyperreflexia, diffuse tremor, and unstable gait. Brain CT described a calcified temporo-lateral meningioma, CSF examination revealed colorless appearing, 560 leucocytes/3microL (97% lymphocytes), 848 mg/L proteins, glycorrhachia: 54 mg/dL (serum glucose: 101 mg/dL), and the multiplex Real-Time PCR test result was negative. On the second day of admission, the patient tested positive for COVID-19 and she was commenced on therapy with remdesivir, ceftriaxone, dexamethasone, and clexane. Adequate hemodialysis sessions were performed. On the eighth day of admission, the diagnosis of WNV infection was made based on the positive serological findings and the presence of IgM antibodies in the cerebrospinal fluid. After 15 days of hospitalization, the patient was discharged in good clinical condition, except for mild tremor in her limbs. Conclusions Periodic epidemic bursts of WNV infection have been reported in Mures County, but present coinfection is rare; the severity and prognosis of the disease are unforeseeable.

Modulating language and executive functions in bilingual aphasia with cerebellar tDCS: a case series.

This study examines the ability to produce phonemes in stroke patients from a neuropsycholinguistic perspective. The case study involved two stroke survivors who experienced disturbances in the frontal lobe (located in the left hemisphere) and were categorized as having moderate strokes. Data were collected through in-depth interviews, audio recordings, and documentation. The analysis employed an interactive data analysis model, which included stages such as data condensation, data presentation, and conclusion drawing. The results indicated that speech production disorders in stroke patients are closely related to aphasia syndromes, particularly Broca's aphasia, which causes articulation difficulties due to weakened motor control of speech organs. Patients were only able to produce limited sentences, typically consisting of four to six words. In addition to the consonant /r/, which is a phoneme with high complexity in tongue movement, there were also difficulties in pronouncing the consonants /s/, /l/, /t/, and /d/, which require coordination of tongue movement with the palate and teeth. Conversely, vowel phoneme production remained within normal limits. Consistent family support plays a significant role in accelerating speech recovery in patients. These findings contribute to a better understanding of post-stroke phonological disorders and can serve as a foundation for developing effective speech rehabilitation strategies.

IntroductionFrontotemporal dementia (FTD) encompasses heterogeneous clinical syndromes, and distinguishing its subtypes using imaging remains challenging.MethodsWe developed a deep learning model to quantify brain atrophy by measuring cerebrospinal fluid (CSF) volumes in key regions of interest (RoIs) on standard MRI scans. In a retrospective study, we analyzed 3D T1-weighted MRI data from 1,854 individuals, including cognitively unimpaired (CU) controls, patients with dementia of the Alzheimer type (DAT), and FTD subtypes: behavioral variant FTD (bvFTD), nonfluent variant primary progressive aphasia (nfvPPA), and semantic variant PPA (svPPA). The model quantified CSF volumes in 14 clinically relevant RoIs and generated age- and sex-adjusted W-scores to express regional atrophy.ResultsEach FTD subtype exhibited a distinct, lateralized atrophy pattern: bvFTD showed widespread bilateral frontal and right-predominant parietal and temporal atrophy; nfvPPA showed left-predominant frontal and parietal atrophy; and svPPA exhibited marked left-lateralized temporal and hippocampal atrophy. All FTD subtypes demonstrated significantly greater CSF expansion in these characteristic regions compared to DAT and CU.DiscussionThis deep learning approach provides a simple, interpretable measure of brain atrophy that differentiates FTD subtypes, requiring only standard MRI with minimal preprocessing, and offers clinical utility.

Effects of Chinese idioms and short sentences on language and cognitive in stroke non-fluent aphasia.