A 78-year-old right-handed man presented with mild right hemiplegia and impaired deep sensation on his right side. He had no aphasia, but showed Gerstmann’s syndrome which is characterized by four primary symptoms: fi nger agnosia, right-left disorientation, agraphia, and acalculia. A cranial CT revealed hemorrhagic lesions in the left thalamus, and single photon emission CT showed decreased regional cerebral blood fl ow in the superior portion of the left temporoparietal lobe, especially angular gyrus area. It is infered that in this case, corticofugal fi bers from the thalamus to the parietal lobe had been damaged by hemorrhage, secondarily causing decreased function of the cerebral cortex.

We compared food and water swallowing tests to investigate the reliability of the tests to exclude aspiration following acute stroke. Subjects were 155 patients with cerebral strokes aged between 20.98 years (66.6±12.9 years) and for whom videofluoroscopic examination of swallowing (VF) was performed for swallowing difficulty or suspected swallowing difficulty. Food tests (FTs) using jelly and rice porridge, and a modified water swallowing test (MWST) were evaluated during VF. The results showed fewer occurrences of choking, cough, wet voice and aspiration during the FTs than in the MWST. The sensitivity and specificity of the FTs for aspiration ranged from 80.0% to 83.3% and 25.5% to 41.3%, respectively. The MWST gave a sensitivity of 58.0% and a specificity of 72.4% for aspiration. There were more incidences of silent aspiration in the MWST than in the FTs. However, the validity of the FTs and their positive predictive value were lower than for the MWST. Choking and cough had a significant relation to aspiration in both tests. We recommend that we need to use each of these tests with an understanding of their characteristics and limitations in order to obtain correct findings in stroke patient swallowing assessments.

Objective : To clarify the characteristics of memory impairment caused by ruptured aneurysm induced subarachnoid hemorrhage, we examined memory function using the auditory verbal learning test (AVLT). Methods : Subjects were 45 patients with subarachnoid hemorrhage caused by ruptured aneurysm in 14 anterior cerebral arteries (ACA), 12 middle cerebral arteries, 7 vertebrobasilar arteries (VA), and 12 internal cerebral arteries. We discussed the scores of short-term memory (STM), total immediate memory (TIM), verbal learning ability (VLA), retroactive interference effect (RI), recognition and learning curve in different portions of ruptured aneurysm. Additionally, we compared them with healthy subjects (HS). Results : The scores of VLA in ACA were lower than that in HS, and the scores of RI in VA were higher than that in HS. There were no difference in STM, TIM and recognition among groups. The learning curve in ACA and VA were flattening in later trials. Conclusion : Because patients after ruptured subarachnoid hemorrhage in ACA and VA have higher rate of memory impairment, we supposed detailed assessment for memory is important.

There are many stroke patients who have eating and swallowing problems after stroke, especially in the acute phase. However, little is known about the relationship between lesion, hematoma volume and pattern of dysphagia in hemorrhagic stroke. Accordingly, we evaluated the clinical features of swallowing function in acute cerebral hemorrhage. Four hundred and forty-seven newly diagnosed acute cerebral hemorrhage patients including 183 putamen, 119 thalamus, 30 cerebellum, 25 brainstem, and 90 subcortical hemorrhages were studied. Patients were referred for bedside swallowing assessment (BSA) using the Repetitive Saliva Swallowing Test and the Modified Water Swallowing Test at initial evaluation. Additionally, videofluoroscopy was performed in 129 patients to determine their oral intake status. The type of diet and outcomes were assessed on discharge. As results, most patients with normal BSA were consuming a regular diet on discharge. However, the number of patients who consumed a regular meal amongst the 289 patients with abnormal BSA was very few. Two hundred ten patients were nutritionally managed using enteral feeding. Lesion site and hematoma volume were related to the BSA result and oral intake outcome at discharge. Eating and swallowing dysfunction is not rare in patients with acute cerebral hemorrhage. We therefore recommend that all patients with cerebral hemorrhage should undergo a swallowing assessment and management in the acute stage.

We investigated the relationship between lifestyle and cognitive function in elderly subjects who had their checkups at a memory clinic. The 136 elderly study subjects included 51 with Alzheimer’s disease, 22 with vascular dementia, 23 with frontotemporal dementia, 25 with mild cognitive impairment, and 15 healthy control. The patients’ lifestyles were assessed using the Frenchay activities index (FAI), and their cognitive functions were assessed by neuropsychological tests, such as the mini-mental status examination and the frontal assessment battery (FAB). The FAI score was lower in the demented patients than in the control subjects. Strong correlations were observed between the FAI scores and the scores in the neuropsychological tests. The FAI scores did not correlate with the educational level or the duration of disease. The fi ndings from the stepwise regression analysis indicated that the FAB score, the number of family members, gender, and age were factors independently affecting the FAI score. The results indicated that the lifestyles of the elderly people might be affected by not only their age and family organization but also their cognitive function. We concluded that cognitive function could play a role in the lifestyle of elderly people.

We report a patient with unilateral midbrain hemorrhage which caused ipsilateral complete oculomotor nerve palsy with pupillary involvement, contralateral upgaze paresis, contralateral limb ataxia and Parinaud’s syndrome. CT scan and MRI brain demonstrated a hemorrhage in the left paramedian midbrain probably involving the oculomotor fascicles; extension of the hemorrhage to the most rostral midbrain may have involved the pupillary fi bers. It was previously thought that a lesion in the superior colliculus, surrounding nuclei (Darkschewitsch and Cajal nuclei), and the posterior commissure (i.e. dorsal midbrain) were responsible for clinical fi ndings similar to those found in our patient, but our patient showed a hemorrhagic lesion in the left ventral midbrain which did not extend to dorsal midbrain. We propose that the responsible lesion in our patient might involve the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF).

Introduction: In the rehabilitation period following a stroke, rehabilitation therapists must thoroughly evaluate the condition of patients for the purposes of goal-setting and effective training. Postgraduate education in the medical examination of patients after stroke was provided for rehabilitation therapists, and changes in their autonomy during medical examinations were subsequently assessed.
Method: The education consisted mainly of reading case reports about patients who had strokes and learning neurological examination techniques. A total of 35 once-weekly education sessions were provided to rehabilitation therapists working in a convalescent rehabilitation ward. The rehabilitation therapists evaluated their independence with respect to obtaining patient backgrounds, vital signs, physical findings, neurological findings, laboratory results, and basic knowledge of illness at the beginning and end of the education sessions and 6 months after the sessions ended. Each evaluation item was compared according to the time of evaluation.
Results: Rehabilitation therapists’ autonomy over obtaining patient backgrounds, neurological findings, laboratory results, and basic knowledge of illness was greater at the end of the education sessions than at the start of the sessions. Their autonomy over obtaining information in these 4 areas and obtaining physical findings was greater 6 months after the end of the education sessions than at the start of the sessions.
Discussion: We conclude that workplace postgraduate training in the medical examination of patients who have had strokes improves rehabilitation therapists’ autonomy during medical assessments.