Verbal Commands Research Articles

A COMPARATIVE STUDY OF KETOFOL (KETAMINE AND PROPOFOL) WITH PROPOFOL ALONE FOR RECOVERY IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Background: To compare the recovery in ketofol (ketamine and propofol) with propofol alone for vas in patients undergoing laparoscopic cholecystectomy
 Methods: Prospective, randomized, double blinded controlled trial. After approval by the research ethics committee and written informed valid consent of the patients, the proposed study was carried out for a period of one year in 60 patients , in ASA-I and ASA-II patients, aged between 19 to 60 years of either sex, who were posted for laproscopic cholecystectomy surgery at Indira Gandhi Medical College, Shimla.
 Results: Recovery profile was statistically significant for two groups. In group P after stopping infusion ,mean time for eye opening was 8.27 ± 1.28 which was less than group K ( 12.53 ± 1.48). Mean time of response to verbal command in group P(8.4 ± 1.19) was less than group K (12.5 ± 1.46) and mean time of extubation in group P (9.5 ± 1.25) was also less than group K (14.33 ± 1.52).
 Conclusion- Patients of Group P after stopping of infusion took less time for eye opening, obeying verbal command and also less time for extubation in comparison to group K .
 Keywords: Recovery, Propofol, Ketamine

Push and pushback: Control behavior as a precipitant of verbal and violent disputes.

We examine to what extent control behavior precipitates disputes involving adversaries in different social relationships. We hypothesize that disputes between intimate partners and illegal business partners are more likely than other disputes to involve control because they involve a higher level of interdependence between the participants. A sample of male inmates (n = 479) and nonoffenders (n = 206) were asked whether control behaviors (e.g., verbal commands) precipitated their most recent disputes (n = 1184). Bivariate probit regression models allowed us to examine mutual control as well as unilateral control. Disputes between intimate partners were more likely than disputes between adversaries in other relationships to be precipitated by mutual control, but not unilateral or one-sided control by men. Disputes between illegal business partners also predicted mutual control, but not unilateral control. Discussions of the motives for violence would benefit from consideration of the classic social psychological literature on power and influence.

Open-World Reasoning for Service Robots

A service robot accepting verbal commands from a human operator is likely to encounter requests that reference objects not currently represented in its knowledge base. In domestic or office settings, the construction of a complete knowledge base would be cumbersome and unlikely to succeed in most real-world deployments. The world that such a robot operates in is thus “open” in the sense that some objects that it must act on in the real world are not described in its internal representation. However, when an operator gives a command referencing an object that the robot has not yet observed (and thus not incorporated into its knowledge base), we can think of the object as being hypothetical to the robot. This paper presents a novel method for closing the robot’s world model for planning purposes by introducing hypothetical objects into the robot’s knowledge base, reasoning about these hypothetical objects, and acting on these hypotheses in the real world. We use our implementation of this method on a domestic service robot as an illustrative demonstration to explore how it works in practice.

Targeted verbal cues can immediately alter gait following stroke

ABSTRACT Background Physical therapists use verbal cueing extensively during gait rehabilitation. Nevertheless, little is known about the ability of individuals post-stroke to make immediate changes to targeted spatiotemporal gait parameters from verbal commands. Additionally, adequate muscle strength may be necessary to promote positive alterations in gait. Objectives To determine the influence of targeted verbal cues on spatiotemporal gait parameters for individuals with chronic stroke. Further, we assessed the potential of a relationship between cue-induced gait modifications and paretic lower limb strength. Methods Using a within-subjects design, twenty-seven adults with chronic stroke walked over a pressure mat with verbal cues to walk at (1) comfortable and (2) fast speeds, with increased (3) arm swing, (4) foot height, (5) step length, (6) push off, and (7) cadence. We also assessed lower extremity strength using a hand-held dynamometer. We measured gait speed, step length, stance time, and cadence for comparisons between conditions and performed correlational analyses to assess the influence of strength on gait alterations. Results Specific cues elicited increased walking speed, cadence, step lengths and paretic limb stance time. Only greater paretic hip and knee flexion strength was related to the ability to increase cadence when cued to do so (r > 0.41). Conclusion With targeted verbal cueing, clinicians can improve step length, gait speed, stance time and cadence for individuals with chronic stroke. Lower extremity strength does not appear to be related to the ability to alter gait with verbal cueing in individuals with chronic stroke.

Toxoplasmosis and tuberculosis: brain lesions in HIV/AIDS differentiated by response to therapy

A 54-year-old man presented with a 1-month history of generalised weakness and a 2-day history of altered sensorium with poor response to verbal commands and repetitive speech, along with headache...

Time to awakening tendency and withdrawal of life supporting treatment (WLST) in patients treated with therapeutic hypothermia after cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objectives Treatment with therapeutic hypothermia after cardiac arrest remains controversial. It is still unclear how long it takes these patients to recover neurological responsiveness, and the time until awakening varies widely. The aim of our study was to identify the patients who had a later awakening and the factors related to late post-arrest awakening. Methods We performed a retrospective analysis of patients admitted in the Coronary Care Unit between 2006 and 2020 after a cardiac arrest. Patients were eligible if they remained comatose after return of spontaneous circulation (ROSC), with a Glasgow Coma Scale less than 10. We measured the time until awakening, defined as obedience to verbal commands. Results Amongst 271 cardiac arrest survivors, 182 remained comatose. Mean age was 65,8 ± 0,98 and there were 29% of females. 70 patients (38,5%) were treated with therapeutic hypothermia with a target temperature of 33ºC using an endovascular device. 60 patients (33%) awakened and median time of awakening was 4 days. The tendency of the awakening was similar if the patient was or not cooled before (Figure1: median: 4, p25: 3, p75: 6). 18 patients (30%) regained neurological responsiveness 5 days after cardiac arrest without differences between groups (p >0,001) (Figure 2: 28,2% cooling group versus 33,3% no control temperature group). We did not find variables associated with a later awakening in the multiple logistic regression analysis adjusted for age, sex, hospital admission year, initial rhythm and Glasgow Scale, and therapeutic hypothermia use. Conclusions The main cause of mortality after a cardiac arrest is the withdrawal of life support treatment. In our cohort, one third of the patients were late awakaners. Therefore, and in consistency with previous reports, we consider that the observation period to assess the neurological outcome should be extended to more than five days before WLST. Abstract Figure 1 and 2

Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness.

Objective: Severe traumatic brain injury (sTBI) often results in disorders of consciousness. Patients emerging from coma frequently exhibit aberrant behaviors such as agitation. These non-purposeful combative behaviors can interfere with medical care. Interestingly, agitation is associated with arousal and is often among the first signs of neurological recovery. A better understanding of these behaviors may shed light on the mechanisms driving the return of consciousness in sTBI patients. This study aims to investigate the association between posttraumatic agitation and the recovery of consciousness.Methods: A retrospective chart review was conducted in 530 adult patients (29.1% female) admitted to Stony Brook University Hospital between January 2011 and December 2019 with a diagnosis of sTBI and Glasgow Coma Scale (GCS) ≤8. Agitation was defined as a Richmond Agitation Sedation Scale (RASS) > +1, or any documentation of equivalently combative and violent behaviors in daily clinical notes. The ability to follow verbal commands was used to define the recovery of consciousness and was assessed daily.Results: Of 530 total sTBI patients, 308 (58.1%) survived. Agitation was present in 169 of all patients and 162 (52.6%) of surviving patients. A total of 273 patients followed commands, and 159 of them developed agitation. Forty patients developed agitation on hospital arrival whereas 119 developed agitation later during their hospital course. Presence of in-hospital agitation positively correlated with command-following (r = 0.315, p < 0.001). The time to develop agitation and time to follow commands showed positive correlation (r = 0.485, p < 0.001). These two events occurred within 3 days in 54 (44.6%) patients, within 7 days in 81 (67.8%) patients, and within 14 days in 96 (80.2%) patients. In 71 (59.7%) patients, agitation developed before command-following; in 36 (30.2%) patients, agitation developed after command-following; in 12 (10.1%) patients, agitation developed on the same day as command-following.Conclusion: Posttraumatic agitation in comatose patients following sTBI is temporally associated with the recovery of consciousness. This behavior indicates the potential for recovery of higher neurological functioning. Further studies are required to identify neural correlates of posttraumatic agitation and recovery of consciousness after sTBI.

Comparison of the influence of low dose etomidate and propofol as priming dose on the incidence of etomidate induced myoclonus: a randomised, double-blind clinical trial

BackgroundThough hemodynamically stable, etomidate is known for its myoclonus side effect following induction. The main aim of this study is an effective attempt to decrease the incidence of myoclonus with a priming agent. MethodsA prospective, double-blind study was carried out on 50 adults posted for elective surgery. After premedication, priming was done with etomidate 0.03 mg.kg-1 (Group E) and propofol 0.2 mg.kg-1 (Group P), i.e., 1/10th of induction dose. After 60 seconds of priming, patients were induced with etomidate by titrating dose over 60 seconds until loss of verbal command and eyelash reflex. The grading of myoclonus, induction dosage, and hemodynamics for 10 minutes post induction were recorded. ResultsIn the study, only 4 cases had myoclonus. Grade 1 myoclonus was encountered in three cases of etomidate group, while only one case in the propofol group had grade 2 myoclonus which was not statistically significant (p-value: 0.12). There was a significant reduction in the etomidate induction dosage in both groups. ConclusionPriming with etomidate and propofol is equally effective in reducing myoclonus with the added benefit of hemodynamic stability and reduction of an induction dose of etomidate (> 50%).

Comparative study of recovery of airway reflexes and cognitive function following sevoflurane versus desflurane anaesthesia.

Background and Aims:Sevoflurane and desflurane have almost similar blood-gas solubility but recent studies suggest that desflurane compared to sevoflurane leads to faster recovery of airway reflexes, but the recovery of cognitive function varies significantly. We conducted this study to compare the times of recovery from anaesthesia following desflurane versus sevoflurane anaesthesia.Methods:This randomised double-blinded study was conducted on 60 patients of American Society of Anesthesiologists (ASA) classification I–II, age between 18 and 60 years with body mass index (BMI) ≤30 kg/m2 who underwent elective cholecystectomy. A standard general anaesthesia protocol was followed with either sevoflurane (group A = 30 patients) or desflurane (group B = 30 patients) along with bispectral index and neuromuscular monitoring. Following extubation, tests for recovery of airway reflexes and cognitive function were conducted and various time intervals were noted. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) standard software version 17.Results:The mean time from first verbal response to first passing the swallowing test was comparable in both the groups (5.50 ± 3.45 vs. 4.10 ± 3.42 min, P value = 0.120). Patients receiving desflurane showed faster response to verbal commands (5.93 ± 4.13 vs. 8.20 ± 3.39 min, P value = 0.024), passed the swallowing test earlier (10.03 ± 4.97 vs. 13.70 ± 3.48 min, P value = 0.009) and Short orientation memory concentration test (SOMCT) earlier (9.83 ± 4.51 vs. 14.10 ± 4.31 min, P value ≤0.001) compared to sevoflurane.Conclusion:In patients undergoing laparoscopic cholecystectomy under controlled conditions, earlier recovery is seen with desflurane compared to sevoflurane.

Effects of attentional focus on upper extremity motor performance in post stroke patients: A randomized pilot study.

Introduction:To facilitate the command to the learner, therapist can use verbal cues for guidance: internal focus (own body) and external focus (consequence of movement in the environment).Objective:To examine the effects of different attentional focus on upper limb motor performance in post-stroke.Methods:Randomized controlled trial with 2 groups. Study realized at Integrated Clinic of the Faculty of Health Science at Trairi (Santa Cruz, Rio Grande do Norte, Brazil). Twelve participants allocated into 2 groups. Two motor tasks were used: task 1, reach-point; task 2, reach-grasp-fit, with the paretic extremity, using verbal commands directed by a trained therapist. In the first phase, Group 1 received commands with internal focus, while Group 2 was instructed with commands with external focus. After 1 week, the command type was changed between groups. The variables collected was movement time, velocity and number of peaks velocityResults:Both attentional focus promoted significant differences in movement time and velocity, however, only Internal Focus provided significant results in both tasks of the same variables.Discussion:The benefits of 1 attentional focus on the other are not fully confirmed. However, not receiving any kind of attention guidance compromises motor performance. The results support the hypothesis that the benefits of the External Focus are accentuated when preceded by the Internal Focus.Clinical Trial Registration:Research Ethics Committee of the Faculty of Helth Science at Trairi (Facisa - UFRN)- Number CAAE 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials - RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/).

A CASE OF MIDDLE CEREBRAL ARTERY INFARCT FOLLOWING UNEVENTFUL CLIPPING OF ANTERIOR COMMUNICATING ARTERY ANEURYSM

Background: Aneurysms of the anterior communicating artery are the most frequently encountered intracerebral aneurysms in routine neurosurgical practice. Management of intracerebral aneurysm involves aneurysm clipping or endovascular coil aneurysm embolisation. However, to the best of our knowledge, there is no reported case of an isolated ipsilateral middle cerebral artery infarction following clipping of anterior communicating artery aneurysm. Case Description: A 65-year-old female with hypertension presented with a history of giddiness, fall and altered sensorium. The patient had a Glasgow Coma Scale (GCS) score of 12, and further investigation of the magnetic resonance imaging on suspicion of stroke revealed subarachnoid haemorrhage in the bilateral parietal sulcus, left Sylvain ssure, left ambient and quadrigeminal cisterns with intra-ventricular extension. The patient was subsequently referred for neurosurgery consultation. Computed tomography (CT) angiogram conrmed the presence of a ruptured anterior communicating artery aneurysm. The neurological assessment showed reduced responsiveness to verbal commands, with a Hunt and Hess score of 3. The patient underwent uneventful clipping of the aneurysm. Postoperatively, the patient did not wake up from anaesthesia and had persistently elevated blood pressure and right-sided hemiplegia. On the third day of postoperative care, a CT head scan revealed a left middle cerebral artery infarction with a midline shift. Decompressive craniotomy was performed, and following this procedure, the patient improved in sensorium with residual right-sided hemiplegia Conclusion: This case report presents an undetected new micro embolism or postoperative cerebral vasospasm as possible causes for the development of cerebral infarct in patients with subarachnoid haemorrhage following an aneurysm rupture.

The autocracy of meaning: Intact visuo-imitative processes may not compensate for meaningful gestures

The dual-route models of action distinguish between a semantic and a non-semantic visuo-motor route to execute different types of gestures. Despite the large amount of evidence in support to the model, some aspects are debated. One issue concerns the recruitment of the visuo-motor route to correctly execute meaningful gestures when the semantic route is damaged. Debated predictions of the dual-route model were investigated in a sample of 32 patients with left hemisphere stroke lesions compared to 27 healthy controls. Group analysis showed that patients were equally impaired on meaningful and meaningless gestures. Single-case analysis demonstrated that most cases were more impaired on meaningful than on meaningless gestures both when they are given in separate lists and when they are intermingled. Impaired performance on the imitation of meaningful gestures in both the separate and mixed list but spared performance on meaningless gestures in the separate list is against the hypothesis that the intact visuo-motor route compensates for damage to the semantic route. These results suggest that the damaged semantic route interferes with the visuo-motor route and prevents the processing of meaningful gestures along the visuo-motor route. Furthermore, an explorative analysis was conducted to investigate the relationship between gestures imitation and pantomime of object use on verbal command and between gestures imitation and performance on linguistic tasks. Although no significant correlation emerged, patients with moderate/severe impairment on the AAT performed significantly worse on meaningful, but not on meaningless gestures than patients with mild/minimal language impairment, suggesting that praxis and language systems are independent but dynamically interact.

Neural reactivity parameters of awareness predetermine one-year survival in patients with disorders of consciousness

ABSTRACT Objective: The current investigation evaluated the sensitivity of neural-reactivity markers of awareness versus standard clinical assessments in predicting 1-year survival in nonresponsive-awake patients with disorders of consciousness (DOC). Methods: Pre-attentive auditory mismatch-negativity (MMN) event-related potentials (ERP’s), globally induced electroencephalography (EEG) spectral power following verbal command, and clinical parameters were assessed. The study included 10 patients with DOC with mixed etiology and 10 healthy controls (HC) at baseline. The clinical status of patients with DOC was reassessed after 1 year. Results: Unlike baseline clinical assessment scores, baseline MMN amplitudes of non-survivors and induced theta-power following verbal-command clearly distinguished the non-surviving patients versus surviving patients. Baseline MMN peak-amplitude latencies in survivors with DOC were significantly related to clinical outcome over a 1-year period. Conclusion: Current findings underscore the increased sensitivity of EEG-reactivity markers of awareness versus standard clinical scores in predicting 1-year clinical outcome and survival in patients with DOC. Further longitudinal research in larger DOC samples is needed to confirm the prognostic-reliability, and validity of neural reactivity parameters of awareness in patients with DOC. Current finding may have implications for clinical care and medical–legal decisions in unresponsive-awake patients, and could assist clinicians to predict their survival up to 1 year from admission.

English

BACKGROUND Ketamine and propofol are one of the commonly used drugs for induction of general anaesthesia. Ketofol, is the combination of ketamine and propofol in varying concentrations. Due to the paucity of information in the literature regarding comparison of different combinations of ketofol for use as an induction agent, we intend to study the various doses of propofol ketamine combination in view of its haemodynamic stability and its relevance to speed of induction as well as side effect profile. METHODS This is a double blinded randomised controlled trial study. 60 patients posted for elective surgery under general anaesthesia were selected. They were randomly allotted to three groups with 20 patients in each group. Group 1 received ketofol in the ratio of 1:1, group 2 in the ratio of 1:2, group 3 in the ratio of 1:3. The time from the start of injection till the loss of verbal command, induction time, was noted. Mean arterial pressure, incidence of apnoea, awareness, hallucinations and post-operative nausea and vomiting (PONV) were noted. RESULTS Induction time was fastest in group 3 followed by group 2 followed by group 1. It was statistically significant. Mean arterial pressure (MAP) was comparable in all the three groups at different time intervals except at 5 minutes after induction, the fall in group 3 was significant. The change in MAP as compared to baseline in group 1 and 2 in different time intervals was not significant. But the fall in MAP was significant as compared to baseline in all the different time intervals in group 3. There was no reported incidence of apnoea, awareness and hallucinations in all the three groups. There were two reported cases of PONV in group 1, one in group 2 and zero in group 3. CONCLUSIONS Ketofol with the maximum propofol and least ketamine combination has the fastest induction time. Ketofol in the combination of 1:1 and 1:2 offers more haemodynamic stability as compared to 1:3 combination and ketofol has minimal side effects. KEY WORDS Ketofol, Different Combinations, Induction Time, Haemodynamic Stability

Implementation of Neural Networks to Frontal Electroencephalography for the Identification of the Transition Responsiveness/Unresponsiveness During Induction of General Anesthesia

ObjectiveGeneral anesthesia is a reversible drug-induced state of altered arousal characterized by loss of responsiveness (LOR) due to brainstem inactivation. Precise identification of the LOR during the induction of general anesthesia is extremely important to provide personalized information on anesthetic requirements and could help maintain an adequate level of anesthesia throughout surgery, ensuring safe and effective care and balancing the avoidance of intraoperative awareness and overdose. So, main objective of this paper was to investigate whether a Convolutional Neural Network (CNN) applied to bilateral frontal electroencephalography (EEG) dataset recorded from patients during opioid-propofol anesthetic procedures identified the exact moment of LOR. Material and methodsA clinical protocol was designed to allow for the characterization of different clinical endpoints throughout the transition to unresponsiveness. Fifty (50) patients were enrolled in the study and data from all was included in the final dataset analysis. While under a constant estimated effect-site concentration of 2.5 ng/mL of remifentanil, an 1% propofol infusion was started at 3.3 mL//h until LOR. The level of responsiveness was assessed by an anesthesiologist every six seconds using a modified version of the Richmond Agitation-Sedation Scale (aRASS). The frontal EEG was acquired using a bilateral bispectral (BIS VISTA™ v2.0, Medtronic, Ireland) sensor. EEG data was then split into 5-second epochs, and for each epoch, the anesthesiologist's classification was used to label it as responsiveness (no-LOR) or unresponsiveness (LOR). All 5-second epochs were then used as inputs for the CNN model to classify the untrained segment as no-LOR or LOR. ResultsThe CNN model was able to identify the transition from no-LOR to LOR successfully, achieving 97.90±0.07% accuracy on the cross-validation set. ConclusionThe obtained results showed that the proposed CNN model was quite efficient in the responsiveness/unresponsiveness classification. We consider our approach constitutes an additional technique to the current methods used in the daily clinical setting where LOR is identified by the loss of response to verbal commands or mechanical stimulus. We therefore hypothesized that automated EEG analysis could be a useful tool to detect the moment of LOR, especially using machine learning approaches.

Surface electromyography and electroencephalography processing in dysarthric patients for verbal commands or speaking intention characterization

Assistance systems for people with Cerebrovascular Accident (CVA) after-effects such as dysarthria are gaining interest due to the increasing proportion of the population with these disorders. This paper proposes the acquisition and processing of surface Electromyography (sEMG) on the facial muscles activated during the process of speaking and Electroencephalography (EEG), synchronized in time by means of an audio file. Data was collected in seven healthy volunteers and seven patients with dysarthria at the Physiotherapy Department of the Porto Alegre Clinical Hospital. The main objective is to classify the biosignals for verbal commands established by Support Vector Machine (SVM) method for the sEMG and Naïve Bayes (NB) method for the EEG. Both methods were compared with the Linear Discriminant Analysis (LDA) method. Extracted features of sEMG signal were: standard deviation, arithmetic mean, skewness, kurtosis and RMS. For the EEG signal, characteristics were extracted in frequency domain such as: minimum, maximum, average and standard deviation, and skewness and kurtosis, in the time domain. As part of the processing method, Common Spatial Pattern (CSP) filters were employed in order to increase the discriminating activity between motion classes in the EEG signal. Mental task identification in healthy and dysarthric subjects reached an accuracy of 77.6–80.8%.

Intention Understanding in Human-Robot Interaction Based on Visual-NLP Semantics.

With the rapid development of robotic and AI technology in recent years, human–robot interaction has made great advancement, making practical social impact. Verbal commands are one of the most direct and frequently used means for human–robot interaction. Currently, such technology can enable robots to execute pre-defined tasks based on simple and direct and explicit language instructions, e.g., certain keywords must be used and detected. However, that is not the natural way for human to communicate. In this paper, we propose a novel task-based framework to enable the robot to comprehend human intentions using visual semantics information, such that the robot is able to satisfy human intentions based on natural language instructions (total three types, namely clear, vague, and feeling, are defined and tested). The proposed framework includes a language semantics module to extract the keywords despite the explicitly of the command instruction, a visual object recognition module to identify the objects in front of the robot, and a similarity computation algorithm to infer the intention based on the given task. The task is then translated into the commands for the robot accordingly. Experiments are performed and validated on a humanoid robot with a defined task: to pick the desired item out of multiple objects on the table, and hand over to one desired user out of multiple human participants. The results show that our algorithm can interact with different types of instructions, even with unseen sentence structures.

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy.

ObjectiveTo investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT).MethodsWe conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables.ResultsPrevalence of PIC was 36.7%. In 912 ECT sessions, the occurrence of PIC was 86 times. Patients with PIC (n = 29) had significant higher body mass index (BMI) (27 ± 6.6 kg/m2 vs 24.1 ± 5.2 kg/m2, t = −2.22, df = 77, p = 0.029) than patients without PIC (n = 50). PIC associated with BMI (Pearson correlation = 0.25, p = 0.029). BMI was significant predictor of PIC after adjusting for other covariates (odds ratio = 0.91, 95% CI= 0.83–0.99, p < 0.035).ConclusionPIC was not uncommon in patients receiving ECT. BMI was an independent predictor of PIC. Psychiatrists should be aware of the risks of PIC in patients with high BMI receiving ECT.

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Some evidence on Gerstmann’s syndrome: A case study on a variant of the clinical disorder

We describe the case of a bilingual patient with persistent symptoms largely, although not fully, consistent with those that are usually reported in Gerstmann’s syndrome. Twenty months after a spontaneous primary intracranial hemorrhage, the patient was evaluated with a series of neuropsychological tasks and underwent an MRI investigation based on Diffusion Tensor Imaging probabilistic tractography. The patient suffered from dysgraphia (difficulty in the access to the graphemic representation of letter forms), autotopoagnosia (difficulties in locating body parts on verbal command), right–left confusion (difficulties in localizing right and left side of symmetrical body parts), and number processing/calculation impairments (predominant difficulties on transcoding tasks). Probabilistic tractography revealed a relatively spared superior longitudinal fasciculus and severe damage to the subcortical white matter connecting the angular gyrus with other parietal regions, such as the intraparietal sulcus and the supramarginal gyrus. Within the framework of the contemporary cognitive accounts of Gerstmann’s syndrome, the case supports the assumption of an anatomical intraparietal disconnection more than a functional Grundstörung (core impairment).