Frank Kastrau

Recovery From Aphasia After Hemicraniectomy for Infarction of the Speech-Dominant Hemisphere

Background and Purpose— The space-occupying effect of cerebral edema limits survival chances of patients with severe ischemic stroke. Besides conventional therapies to reduce intracranial pressure, hemicraniectomy can be considered as a therapeutic option after space-occupying cerebral infarction. There is controversy regarding the use of this method in patients with infarction of the speech-dominant hemisphere. Methods— In 14 patients with infarction of the dominant hemisphere and subsequent treatment with hemicraniectomy, recovery from aphasic symptoms was evaluated retrospectively. A group of patients who were treated between 1994 and 2003 in our aphasia ward was selected for the study. In all patients, a psychometric quantification was accomplished applying the Aachen Aphasia Test at least twice within a mean observation period of 470 days. Results— A significant improvement of the statistical parameters representing different aspects of aphasia was observed in 13 of 14 patients. Also, an increase of the ability to communicate was evident in 13 patients. Young age at the time of stroke and early poststroke decompressive surgery were identified as main predictors for recovery from aphasia. Conclusions— A significant improvement of aphasic symptoms can be observed in a preselected group of patients after a massive stroke of the speech-dominant hemisphere treated by consecutive hemicraniectomy. Therefore, decompressive surgery can be considered for the treatment of this kind of stroke.

The subcortical role of language processing. High level linguistic features such as ambiguity-resolution and the human brain; an fMRI study

In the present study, we were interested in the neurofunctional representations of ambiguity processing by using functional magnetic resonance imaging (fMRI). Twelve right-handed, healthy adults aged between 21 and 29 years (6 male, 6 female) underwent an ambiguity resolution task with 4 different conditions (dominant vs. non-dominant; dominant vs. distractor; non-dominant vs. distractor; distractor vs. distractor). After subtraction of the corresponding control task (distractor vs. distractor) we found significant activation especially in the thalamus and some parts of the basal ganglia (caudate nucleus, putamen). Our findings implicate a participation of the thalamus and other basal ganglia circuits in high level linguistic functions and match with theoretical considerations on this highly controversial topic. Subcortical neural circuits probably become activated when the language processing system cannot rely entirely on automatic mechanisms but has to recruit controlled processes as well. Furthermore, we found broad activation in the inferior parietal lobule, the prefrontal gyrus, pre-SMA and SMA and the cingulate cortex. This might reflect a strategic semantic search mechanism which probably can be illustrated with connectionist models of language processing. According to this, we hypothesize a neuroregulatory role for the thalamus and basal ganglia in regulating and monitoring the release of preformulated language segments for motor programming and semantic verification. According to our findings there is strong evidence, that especially the thalamus, the caudate nucleus, the cingulate cortex, the inferior parietal lobule and the prefrontal cortex are responsible for an accurate ambiguity resolution in the human brain.

The neurofunctional mechanisms of traumatic and non-traumatic memory in patients with acute PTSD following accident trauma

Neurofunctional alterations in acute posttraumatic stress disorder (PTSD) and changes thereof during the course of the disease are not well investigated. We used functional magnetic resonance imaging to assess the functional neuroanatomy of emotional memory in surgical patients with acute PTSD. Traumatic (relative to non-traumatic) memories increased neural activity in the amygdala, hippocampus, lateral temporal, retrosplenial, and anterior cingulate cortices. These regions are all implicated in memory and emotion. A comparison of findings with data on chronic PTSD suggests that brain circuits affected by the acute disorder are extended and unstable while chronic disease is characterized by circumscribed and stable neurofunctional abnormalities.

An fMRI study on conceptual, grammatical, and morpho-phonological processing

The aim of the present study was to determine whether processing of syntactic word information (lemma) is subserved by the same neural substrate as processing of conceptual or word form information (lexeme). We measured BOLD responses in 14 native speakers of German in three different decision tasks, each focussing specifically on one level of lexical processing (conceptual, syntactic, and morpho-phonological). The test parameters were natural gender, grammatical gender, and word form derivation, respectively. Discrimination between words played backwards and complex sounds served as control task. Complex contrasts revealed a functional fractionation of the left inferior frontal gyrus for each level of lexical processing.

The processing of lexical ambiguity in healthy ageing and Parkinson׳s disease: Role of cortico-subcortical networks

Previous neuroimaging studies showed that correct resolution of lexical ambiguity relies on the integrity of prefrontal and inferior parietal cortices. Whereas prefrontal brain areas were associated with executive control over semantic selection, inferior parietal areas were linked with access to modality-independent representations of semantic memory. Yet insufficiently understood is the contribution of subcortical structures in ambiguity processing. Patients with disturbed basal ganglia function such as Parkinson׳s disease (PD) showed development of discourse comprehension deficits evoked by lexical ambiguity. To further investigate the engagement of cortico-subcortical networks functional Magnetic Resonance Imaging (fMRI) was monitored during ambiguity resolution in eight early PD patients without dementia and 14 age- and education-matched controls. Participants were required to relate meanings to a lexically ambiguous target (homonym). Each stimulus consisted of two words arranged on top of a screen, which had to be attributed to a homonym at the bottom. Brain activity was found in bilateral inferior parietal (BA 39), right middle temporal (BA 21/22), left middle frontal (BA 10) and bilateral inferior frontal areas (BA 45/46). Extent and amplitude of activity in the angular gyrus changed depending on semantic association strength that varied between conditions. Less activity in the left caudate was associated with semantic integration deficits in PD. The results of the present study suggest a relationship between subtle language deficits and early stages of basal ganglia dysfunction. Uncovering impairments in ambiguity resolution may be of future use in the neuropsychological assessment of non-motor deficits in PD.

Perception of Signs and Written Words: An Fmri Study

PERCEPTION OF SIGNS AND WRITTEN WORDS: AN fMRI STUDY Juliane Klann1, Frank Kastrau2, Stefan Kémeny2 and Walter Huber1 (1Neurolinguistics and 2Neurology at the Department of Neurology, University Hospital Aachen, Germany)