Abstract Following the seminal discoveries of Broca18 and Wernicke106 that focal left hemi sphere lesions may cause profound deficits of language, neurological studies of human communication have, for the most part, focused on left hemisphere injury and resultant aphasias.
Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions in which a subjective decrease in emotional range serves as a diagnostic criterion. In order to investigate whether veterans with chronic PTSD also experienced objective limitations in emotional perception, the authors administered the Aprosodia Battery to a group of 11 veterans with chronic PTSD, nine subjects with right hemisphere damage, seven subjects with left hemisphere damage, and 12 comparison subjects. The patients with PTSD displayed significant deficiencies in the comprehension and discriminative components of affective speech, similar in severity and performance profile on the Aprosodia Battery to the individuals with focal right hemisphere damage due to ischemic infarction.
In adults, the affective components of language, including certain aspects of prosody and gesturing, appear to be a dominant function of the right hemisphere. The various combinations of affective processing deficits associated with focal right brain damage are called aprosodias and have functional and anatomical correlates similar to the propositional language deficits associated with aphasias secondary to focal left brain damage. Developmental affective-prosodic deficits have been reported recently in children with congenital or very early right hemisphere injury. We now report two school-aged children with acquired motor-type aprosodias following acute right focal brain injury. Their affective prosody and singing were also analyzed acoustically during the acute and recovery phases of illness. Based on these cases, we propose the term children aprosodia to describe affective-prosodic deficits that result from acquired lesions of the right hemisphere in children. ( J Child Neurol 1990;5:19-26).
Hypothesis: Early intervention in VaMCI leads to improved management of vascular risk factors and decreased utilization of hospital resources. Methods: An individualized patient and family education session encouraging increased supervision of medication use, specifically for antiplatelets, statins, antihypertensives, diabetes medications and anticoagulants, was implemented at the time of diagnosis and continued at 6-month intervals. Medication adherence, treatment parameters and number of individuals with emergency room (ER) visits or hospital admissions were recorded in 72 consecutive patients for 12 months before and after the VaMCI diagnosis. Treatment parameters included average systolic (SBP) and diastolic (DBP) blood pressure, LDL, HgA1c and percentage of INR within therapeutic range. Non-adherence was defined as a lag of ≥3 months in refills over 12 months. Results: Improved adherence for antiplatelets (55% to 94%), statins (68% to 94%) and antihypertensives (59% to 93%; p’s <0.0001), decreases in average SBP (-8.6 mmHg, p<0.0001), DBP (-3.2 mmHg, p=0.01), LDL (-9.4, p<0.0001), and HgA1c (-0.4%, p=0.001) and increased percentage of INR within therapeutic range (+21%, p=0.001) were noted after the intervention. The number of ER visits and/or hospital admissions declined after the intervention (36 vs 20, p=0.001) with a decline in one ER visit or hospital admission for every three patients receiving the intervention. Logistic regression showed that improved adherence to antiplatelets was the only significant predictor of a decline in ER visits or hospital admissions (OR=3.0, p=0.04). Conclusions: Medication adherence counselling for VaMCl patients leads to improved treatment of risk factors and decreased utilization of hospital resources. The strongest predictor of reduced ER visits and admissions in our cohort was improved adherence to antiplatelet therapy.
This chapter presents two cases that were unique in that they provided clinical evidence that amnestic memory loss, depending on the location of the lesion, could be sensory-specific rather than multimodal, in support of the experimental animal literature discussed. The patients demonstrated that verbal and non-verbal auditory and right and left tactile recent memory functions could be preserved when there was loss of visual recent memory functions. Both patients also had other behavioral and elementary neurological deficits related to the lesion location, but none could explain their sensory-specific visual amnesia. Fleming made his inductive discovery that initiated a line of deductive research, which ultimately led to the identification and commercial development of penicillin, investigators, including Fleming, threw away their "contaminated" petri dishes. Based on a review of the literature citing Ross using the Web of Science, it is clear that the cases have not been incorporated into current neuropsychological theories of the normal mind, including memory and remembering, other than individual researchers interested in the neurobiology of disconnection syndromes or the neuroanatomical basis of clinical syndromes.
