Claus-W. Wallesch

Neuropsychological sequelae of diffuse traumatic brain injury

Primary objectives: Description and analysis of neuropsychological deficits following brain trauma with diffuse lesion probably corresponding to diffuse axonal injury (DAI).Research design: A series of 111 patients suffering from traumatic brain injury could be investigated neuropsychologically within the first 4 weeks after injury and re-assessed after 5–8 months. They included 11 subjects with CT-evidence of diffuse axonal injury, but no CT-signs of focal contusions. Eleven patients with focal frontal contusions but no CT signs of DAI were matched to and compared with the DAI subjects. Seventeen TBI patients with normal CT scans served as controls.Results: When assessed within the first 4 weeks after TBI, both DAI and frontal contusion patients exhibited behavioural abnormalities and deficits in Wechsler Similarities. The DAI patients were also impaired in Digit Span backward and Stroop interference. When re-assessed, the DAI patients showed considerable deficits in the California Verbal Learning Test and in the Wisconsin Card Sorting Test.Conclusions: DAI leads to neuropsychological impairment dominated by executive and memory dysfunction.

Poststroke Depression Is There a Pathoanatomic Correlate for Depression in the Postacute Stage of Stroke

BACKGROUND AND PURPOSE This study is aimed at the pathoanatomic correlates of depression in the postacute stage of patients with stroke. METHODS Of a consecutive series of 104 stroke patients, a subgroup of 47 patients with single demarcated unilateral lesions was selected. Clinical examination, neuroradiological CT scan examination, and psychiatric assessment were performed within a 2-month period after the acute stroke. Depression was assessed with the Cornell Depression Scale, the Montgomery-Asberg Depression Rating Scale, and according to modified DSM-III-R criteria. The neuroradiological examination of all patients was performed on the same scanner, and lesion location, lesion volume, and ventricle-to-brain ratio were analyzed. RESULTS We found no significant differences in depression scores between patients with left and right hemisphere lesions and no correlation between the severity of depression and the anteriority and the volume of lesion or brain atrophy. Major depressive disorders were only found in nine patients with left hemisphere lesions, all involving the basal ganglia, whereas none of the patients with right hemisphere stroke exhibited major depression. CONCLUSIONS Lesions in the vicinity of the left hemisphere basal ganglia tend to play a crucial role in the development of major depression after the acute stage of stroke. The pathophysiological implications of this finding are discussed.

Release of neurobiochemical markers of brain damage is related to the neurovascular status on admission and the site of arterial occlusion in acute ischemic stroke.

OBJECTIVES The study aimed at an analysis of the kinetics of protein S100B and neuron-specific enolase (NSE) and their relation to the site of arterial occlusion in patients with acute ischemic stroke. METHODS We investigated 32 consecutive patients admitted within 6 h after stroke onset. Serial venous blood samples were taken hourly between 1 and 6 h, and at 12, 18, 24, 48, 72, 96, and 120 h after stroke onset. The neurovascular status was assessed on admission and monitored by repetitive extracranial and transcranial duplex sonography. In all patients, infarct volume was calculated. The neurological deficit was quantified by the National Institutes of Health stroke scale score, and functional outcome after 3 months was assessed with the modified Rankin Scale. RESULTS Patients with normal flow velocities in basal cerebral arteries at admission showed significantly less S100B release than those with main stem or multiple branch occlusions (p<0.01). S100B cut-off values of 0.15 microg/l (between 6 and 18 h), 0.21 microg/l (between 24 and 48 h) and 0.5 microg/l (from 72 to 120 h) differentiated best between patients with initially normal and pathological sonographic vessel findings. The release of S100B and NSE was highly correlated with the severity of the corresponding neurological deficit as well as with the final infarct volume. S100B concentrations from 6 h on were associated with the functional outcome. S100B values 48 h after stroke above 0.2 microg/l indicated a poor functional status 3 months after stroke. CONCLUSIONS Protein S100B may serve as a monitoring parameter in acute ischemic stroke, especially with respect to the neurovascular status. Furthermore, S100B obtains additional information about functional outcome.

Long-term effects of cerebellar pathology on cognitive functions

Twelve patients with circumscribed chronic neocerebellar lesions but without CT-evidence of forebrain damage (other than the effects of shunting) were investigated for deficits of cognitive functions. Two different mechanisms were considered as possible causes of cognitive impairment: (1) Damage to the dentato-thalamo-cortical projection leading to impairments of cortical functions, and (2) prolonged intracranial pressure resulting in diffuse forebrain damage and subcortical dementia. Patients with lesions in the left neocerebellum showed deficits in cognitive operations in three dimensional space, consistent with the right forebrain dominance for spatial functions. Prolonged intracranial pressure, on the other hand, resulted in a mild overall cognitive impairment.

Depression in acute and chronic aphasia: symptoms, pathoanatomical-clinical correlations and functional implications.

Depressive alterations were investigated in 21 acute and 21 chronic aphasic patients with single left sided strokes. The assessment of depression was based on a psychometrically evaluated German version of the Cornell Scale for Depression (CDS) and the Research Diagnostic Criteria (RDC). No significant difference was found concerning depression sum-scores between the two aphasic groups. The acute group, however, exhibited significantly higher ratings in items related to physical signs of depression and disturbances of cyclic functions. Patients corresponding to the RDC-syndrome of major depression were only found in the acute group. Neither age, sex nor degree of hemiparesis discriminated the patients on the severity of depressive symptoms. In the acute patient group, nonfluency of aphasia was the only parameter that could be identified which had an effect on the mood symptom scores. A CT scan analysis in the acute patient group showed an association between the severity of depression and anterior lesions. A significant correlation was found between CDS sum-scores and the proximity of the anterior border of the lesion to the frontal pole of the hemisphere whereas the volume of lesions seemed to have no effect on depressive alterations in acute aphasic patients. Superimposition of the lesions of the aphasic patients with major depressive disorders showed a common subcortical lesion area involving putaminal and external pallidal structures.

Spontaneous speech in senile dementia and aphasia: Implications for a neurolinguistic model of language production

Abstract We analyzed spontaneous speech production in semi-standardized interviews conducted with 10 patients suffering from moderate senile dementia of the Alzheimer type (SDAT), 5 Wernickes aphasics, and 5 elderly controls without brain damage. Data analysis revealed in both patient groups a reduction of sentence length but absence of systematic paragrammatic symptoms on the part of the demented patients. A relatively selectively diminished use of nouns was striking in the production of both patient groups, whereas word finding ability was surprisingly well preserved in the SDAT patients. Both patient groups exhibited marked deficits but different patterns of pathological behaviour on the discourse level of responding to the interviewers questions. Results are interpreted within a proposed neurolinguistic language production model. It is argued that the formulation process may be preserved in demented patients but is disturbed in aphasia. Language-related disturbances in senile dementia are assumed to result from pre-linguistic disorders in the formation of the conceptual structure of the intended speech act.

Release of brain–type and heart–type fatty acid–binding proteins in serum after acute ischaemic stroke

This study aimed at an analysis of the release of Braintype and Heart–type Fatty Acid– Binding Proteins (B–FABP and HFABP) in acute ischaemic stroke and their potential value as neurobiochemical markers of brain damage.We investigated 42 consecutive patients admitted within 6 hours after ischaemic stroke. Serial venous blood samples were taken hourly between 1 to 6 hours, and at 12, 18, 24, 48, 72, 96, and 120 hours after stroke onset. In all patients lesion topography was assessed and infarct volume was calculated. The neurological deficit was quantified by the National Institutes of Health stroke scale score, and functional outcome was assessed with the modified Rankin Scale 3 months after stroke.H–FABP and B–FABP concentrations showed peak values already 2 to 3 hours after stroke onset and remained elevated up to last measurements at 120 hours.Unlike BFABP, early H–FABP concentrations were significantly associated with the severity of the neurological deficit and the functional outcome. High H–FABP release was associated with large infarction on CT.Our study shows for the first time quantitative data of serum BFABP and H–FABP being elevated early in acute ischaemic stroke indicating that especially H–FABP might have the potential to be a rapid marker of brain damage and clinical severity. As both FABPs indicate damage to neuronal and glial tissue but are not specific for cerebral infarction, further investigations are needed to better understand the prolonged release of both in ischaemic stroke which is in contrast to the transient increase after myocardial infarction and can not be explained by their renal extraction.

Observations on regional cerebral blood flow in cortical and subcortical structures during language production in normal man

Regional cerebral blood flow (rCBF) was studied by single photon emission computerized tomography (SPECT) of inhaled xenon-133 in six normal volunteers during various language, articulatory, and control conditions. Language production increased rCBF in predominantly left-sided cortical and subcortical areas. The involved regions were anatomically related to a left frontal area (Brocas), to both caudate nuclei, to a left thalamic/pallidal area, and bilaterally in retrorolandic areas. The failure to demonstrate lateralized retrorolandic activity is thought to reflect the complexity of the tasks.

Effect of coenzyme Q10 on the mitochondrial function of skin fibroblasts from Parkinson patients.

Several lines of evidence suggest an impairment of mitochondrial function in the brain of patients with Parkinsons disease (PD). However, the presence of a detectable mitochondrial defect in extracerebral tissue of these patients remains a matter of dispute. Therefore, we investigated mitochondrial function in fibroblasts of 18 PD patients applying biochemical micromethods. Putative beneficial effects of coenzyme Q(10) (CoQ(10)), a potent antioxidant, on the mitochondrial function of skin fibroblast cultures were evaluated. Applying inhibitor titrations of the mitochondrial respiration to calculate flux control coefficients of respiratory chain complexes I and IV, we observed deficiencies of both complexes in cultivated skin fibroblasts of PD patients. Cultivation of fibroblasts in the presence of 5 microM CoQ(10) restored the activity of impaired respiratory chain complexes in the fibroblast cultures of 9 out of 18 PD patients. Our data support the presence of a generalised mitochondrial defect in at least a subgroup of patients with PD that can be partially ameliorated in vitro by coenzyme Q(10) treatment.

Psychosocial changes and psychosocial adjustment with chronic and severe nonfluent aphasia

Abstract Data concerning type and degree of psychological changes resulting from communicative impairment were obtained from close relatives of 20 chronic non-fluent aphasics by means of a structured and standardized interview. Expectations concerning further psychosocial adaptation were assessed with a modified translation of the ‘Code-Muller Scale of Psychosocial Adjustment’ in patients, relatives, and the speech therapists concerned. The data demonstrate that patients and relatives suffer from considerable psychosocial strain. Patients and relatives estimated the probability of an improvement of psychosocial adjustment as being significantly higher than the speech therapists did, a finding which replicated the results obtained by Muller and his colleagues.