Posts Tagged ‘stroke’

“Foreign Accent Syndrome” (FAS) is a rare disorder in which patients start to speak with a foreign or regional tone. This striking condition is often associated with brain damage, such as stroke. Presumably, the lesion affects the neural pathways by which the brain controls the tongue and vocal cords, thus producing a strange sounding speech.

Yet there may be more to FAS than meets the eye (or ear). According to a new paper in the Journal of Neurology, Neurosurgery and Psychiatry, many or even most cases of FAS are ‘functional’, meaning that the cause of the symptoms lies in psychological processes rather than a brain lesion.

To reach this conclusion, authors Laura McWhirter and colleagues recruited 49 self-described FAS suffers from two online communities to participate in a study. All were English-speaking. The most common reported foreign accents were Italian (12 cases), Eastern European (11), French (8) and German (7), but more obscure accents were also reported including Dutch, Nigerian, and Croatian.

Participants submitted a recording of their voice for assessment by speech experts, as well as answering questions about their symptoms, other health conditions, and personal situation. McWhirter et al. classified 35 of the 49 patients (71%) as having ‘probably functional’ FAS, while only 10/49 (20%) were said to probably have a neurological basis, with the rest unclear.

These classifications are somewhat subjective in that there are no hard-and-fast criteria for functional FAS. None of the ‘functional’ cases reported hard evidence of neurological damage from a brain scan, but only 50% of the ‘neurological’ cases did report such evidence. The presence of other ‘functional’ symptoms such as irritable bowel syndrome (IBS) was higher in the ‘functional’ group.

In terms of the characteristics of the foreign accents, patients with a presumed functional origin often presented with speech patterns that showed inconsistency or variability. For instance, pronouncing ‘cookie jar’ as ‘tutty dar’ but being able to correctly produce ‘j’, /k/, /g/ and ‘sh’ sounds as part of other words.

But if FAS is often a psychological disorder, what is the psychology behind it? McWhirtner et al. don’t get into this, but it is interesting to note that FAS is often a media-friendly condition. In recent years there have been many news stories dedicated to individual FAS cases. To take just three:

American beauty queen with Foreign Accent Syndrome sounds IRISH, AUSTRALIAN and BRITISH
https://www.mirror.co.uk/news/weird-news/you-sound-like-spice-girl-11993052

Scouse mum regains speech after stroke – but is shocked when her accent turns Russian
https://www.liverpoolecho.co.uk/news/liverpool-news/scouse-mum-regains-speech-after-15931862

Traumatic car accident victim has Irish accent after suffering severe brain injury
https://www.irishcentral.com/news/brain-injury-foreign-accent-syndrome

http://blogs.discovermagazine.com/neuroskeptic/2019/03/09/curious-foreign-accent-syndrome/#.XI58R6BKiUn

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By Bahar Gholipour

A 49-year-old man in Brazil survived a stroke but underwent a strange personality change afterward — he developed “pathological generosity,” according to a report of his case.

His willingness to give liberally to others – including people he barely knew — dramatically changed his life. He would spend his money on children he met on the street, buying them soda, candies and junk food, his wife told the doctors. Mr. A, as the man is called in the case report, became unable to manage his financial life, or resume his job as a department manager within a large corporation.

The stroke apparently left Mr. A with “excessive and persistent generosity,” the researchers, led by Dr. Leonardo Fontenelle from the Federal University of Rio de Janeiro.

“Stroke can cause a whole variety of neuropsychological and behavioral changes,” said Dr. Larry Goldstein, neurologist and director of the Stroke Center at Duke University, who wasn’t involved with the case. “Although the observation of personality change is not that unusual, this particular one is apparently novel,” he told LiveScience.

Very often, a behavior change after a stroke depends on the extent of injury and the location of the injury in the brain, Goldstein said.


How stroke affects personality

A stroke occurs when a blood clot blocks the blood supply to the brain, or when a blood vessel in the brain bursts. Brain damage caused by low oxygen supply can lead to emotional changes, most commonly depression, but strokes have also been known to cause pathological laughing or crying, or neglect syndrome, in which people don’t recognize one side of their visual field.

In Mr. A’s case, the stroke was due to bleeding in the brain, related to his high blood pressure.

Understanding exactly what change in the brain was driving Mr. A’s excessive generosity is very interesting for scientists, especially because the condition is in many respects the opposite of disorders such as hoarding and sociopathy, the researchers said.

Doctors determined Mr. A’s stroke occurred in a subcortical region, (below the cerebral cortex, where higher-level thinking occurs), and the damage could have affected brain areas associated with regulating normal behaviors.

But knowing the location of a stroke doesn’t necessarily predict the behavioral change. The networking that happens in the brain means there are often effects in areas of the brain not right next to the injury, Goldstein said.

Studies have pointed to a couple of brain structures as being involved in acts of generosity, such as anonymously donating to charities. These brain structures include the brain’s reward system, the researchers said.

A life forever changed?

Mr. A’s pathological generosity may provide new insights into which brain areas affect “the delicate balance between altruism and egoism, which make up one of the pillars of ordinary social motivation and decision making,” the researchers said.

Other instances of excessive benevolent behavior have been seen in cases of people with mania, Parkinson’s disease treated by certain medications, and forms of dementia.

When doctors carried out a psychological evaluation of Mr. A, they didn’t find any evidence of manic symptoms or dementia. Mr. A. reported being depressed, forgetful and unable to pay attention. He also showed some behaviors that have been linked to damage in the frontal lobe of the brain, including lack of persistence and planning, and impaired judgment, according to the report.

A CT scan showed blood flow to several brain regions, including areas in the frontal lobe, was low. These regions, although far from the bleed focus, are connected with it by neural pathways. The damage in these pathways might have disrupted the interplay of neural systems that underpin key dimensions of personality, the researchers said.

Mr. A was put on medication to treat his depression. After two years, he said he felt cured, and stopped the depression treatment, but his pathological generosity was unchanged. He was aware of changes in his behavior. According to the researchers, he often claimed, “I saw death from up-close, now I want to be in high spirits.”

When doctors asked whether he intended to resume his former job, he replied that he had already worked enough, and that it was now time “to enjoy life, which is too short.”

https://www.livescience.com/39416-pathological-generosity-stroke.html

by Leigh Hopper

Tnew stroke-healing gel created by UCLA researchers helped regrow neurons and blood vessels in mice whose brains had been damaged by strokes. The finding is reported May 21 in Nature Materials.

“We tested this in laboratory mice to determine if it would repair the brain and lead to recovery in a model of stroke,” said Dr. S. Thomas Carmichael, professor of neurology at the David Geffen School of Medicine at UCLA. “The study indicated that new brain tissue can be regenerated in what was previously just an inactive brain scar after stroke.”

The results suggest that such an approach could some day be used to treat people who have had a stroke, said Tatiana Segura, a former professor of chemical and biomolecular engineering at UCLA who collaborated on the research. Segura is now a professor at Duke University.

The brain has a limited capacity for recovery after stroke. Unlike the liver, skin and some other organs, the brain does not regenerate new connections, blood vessels or tissue structures after it is damaged. Instead, dead brain tissue is absorbed, which leaves a cavity devoid of blood vessels, neurons or axons — the thin nerve fibers that project from neurons.

To see if healthy tissue surrounding the cavity could be coaxed into healing the stroke injury, Segura engineered a hydrogel that, when injected into the cavity, thickens to create a scaffolding into which blood vessels and neurons can grow. The gel is infused with medications that stimulate blood vessel growth and suppress inflammation, since inflammation results in scars and impedes functional tissue from regrowing.

After 16 weeks, the stroke cavities contained regenerated brain tissue, including new neuronal connections — a result that had not been seen before. The mice’s ability to reach for food improved, a sign of improved motor behavior, although the exact mechanism for the improvement wasn’t clear.

“The new axons could actually be working,” Segura said. “Or the new tissue could be improving the performance of the surrounding, unharmed brain tissue.”

The gel was eventually absorbed by the body, leaving behind only new tissue.

The research was designed to explore recovery in acute stroke, the period immediately following a stroke — in mice, that period lasts five days; in humans, it’s two months. Next, Carmichael and Segura plan to investigate whether brain tissue can be regenerated in mice long after the stroke injury. More than 6 million Americans are living with long-term effects of stroke, which is known as chronic stroke.

The other authors of the paper are Lina Nih and Shiva Gojgini, both of UCLA.

The study was supported by the National Institutes of Health.

http://newsroom.ucla.edu/releases/biomaterial-ucla-regrow-brain-tissue-after-stroke-mice

The time window for treating stroke patients may be considerably longer than doctors previously thought. Results from a multi-center clinical trial published Jan. 24 in the New England Journal of Medicine show that certain stroke patients can be successfully treated up to 16 hours after stroke.

Key to the success of the treatment was the use of advanced brain imaging that can identify stroke patients who still have salvageable brain tissue if blood flow can be restored. The study demonstrated that physically removing brain clots up to 16 hours after symptom onset in these selected patients led to improved outcomes compared to standard medical therapy.

University of Iowa Hospitals and Clinics was one of 38 stroke centers involved in the new study known as the Endovascular Therapy Following Imaging Evaluation for the Ischemic Stroke (DEFUSE 3) trial. The trial was led by researchers at Stanford University School of Medicine in California and funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health. The findings also were presented Jan. 24 at the International Stroke Conference in Los Angeles.

“This study will provide us with the opportunity to offer a life-saving and life-changing therapy to thousands of people,” says Santiago Ortega, MD, clinical assistant professor and neurointerventional surgery director in the UI Department of Neurology and principal investigator for the UI DEFUSE 3 study site. “As the top enrolling center in the study, the UI was an important contributor to this advance in the field of stroke and improving the treatment of this devastating disease.”


Saving brain tissue

Ischemic stroke occurs when a cerebral blood vessel becomes blocked, cutting off the delivery of oxygen and nutrients to brain tissue. The area immediately surrounding the blockage is known as the core. When a stroke occurs, brain tissue in the core typically cannot be saved, and the core can expand over time. However, physicians have long believed that tissue in the area surrounding the core (known as the ischemic penumbra) can potentially be saved based on how quickly blood flow can be restored.

The key to the new study was an advanced brain scan called perfusion imaging, which measures blood flow in brain tissue. Perfusion imaging can identify patients with brain tissue that can still be salvaged by removing the blockage.

Using an automated software to analyze perfusion MRI or CT scans, the DEFUSE 3 researchers identified patients thought to have salvageable tissue up to 16 hours after stroke onset. The participants were randomized to either receive endovascular thrombectomy plus standard medical therapy or medical therapy alone.

Endovascular thrombectomy, or the physical removal of the blockage, is currently approved for use up to six hours following onset of stroke symptoms. The DEFUSE 3 researchers discovered that this intervention can be effective up to 16 hours after symptoms begin in this select group of patients. The findings also showed that patients in the thrombectomy group had substantially better outcomes 90 days after treatment compared to those in the medical therapy control group. For example, 45 percent of the patients treated with the clot removal procedure achieved functional independence compared to 17 percent in the control group. Thrombectomy treatment was also associated with improved survival. According to the results, 14 percent of the treated group had died within 90 days of the study, compared to 26 percent in the control group.

The DEFUSE 3 results along with other recent trials are so compelling they have provided a basis for significant changes in the guidelines for managing acute stroke. The new guidelines, announced Jan. 24 by the American Heart Association/American Stroke Association, recommend thrombectomy in eligible patients six to 16 hours after a stroke.


DEFUSE 3 study at UI

The DEFUSE 3 study was supported by NINDS’ StrokeNet, a network of hospitals providing research infrastructure for multi-site clinical trials in stroke care. The UI is one of StrokeNet’s 25 Regional Coordinating Centers (RCC), and the UI site enrolled the highest number of participants (15 of 182) in the DEFUSE 3 study. Enrique Leira, MD, director of the UI Comprehensive Stroke Center is the principal investigator for the StrokeNet UIRCC. Leira, along with Harold Adams, MD, UI professor of neurology, have been instrumental in establishing the UI Comprehensive Stroke Center as a national leader in stroke care.

“UI Comprehensive Stroke Center team has worked hard on developing an acute endovascular protocol and infrastructure to expedite the assessment and treatment of patients suffering from this devastating disease in our state,” Ortega says. “Numerous members from different departments including, EMS personnel, emergency medicine physicians and nurses, radiology technologists, neurologists, anesthesiologist and OR nurses, and neurointerventional surgeons are constantly involved in the process and deserve recognition for their important contributions to the success of this study.”

Colin Derdeyn, MD, professor and DEO of the UI Department of Radiology, who also served on the DEFUSE 3 central steering committee, adds his praise for the study team’s work.

“Our success in this trial is related to several factors, one being Dr. Ortega’s great leadership and the work of his team, of which I am glad to be a part. Another major reason is the incredible network built by Dr. Adams and Dr. Leira to provide fast, state-of-the-art care to patients affected by acute stroke across Iowa,” Derdeyn says. “I am not aware of another institution in the country that supports so many small rural hospitals and accepts so many stroke patients in transfer for advanced care and access to really important trials like this.”

https://medcom.uiowa.edu/theloop/news/stroke-patients-can-be-successfully-treated-up-to-16-hours-after-stroke

Why do some people remain healthy into their 80s and beyond, while others age faster and suffer serious diseases decades earlier? New research led by UCLA life scientists may produce a new way to answer that question—and an approach that could help delay declines in health.

Specifically, the study suggests that analyzing intestinal bacteria could be a promising way to predict health outcomes as we age.

The researchers discovered changes within intestinal microbes that precede and predict the death of fruit flies. The findings were published in the open-source journal Cell Reports.

“Age-onset decline is very tightly linked to changes within the community of gut microbes,” said David Walker, a UCLA professor of integrative biology and physiology, and senior author of the research. “With age, the number of bacterial cells increase substantially and the composition of bacterial groups changes.”

The study used fruit flies in part because although their typical life span is just eight weeks, some live to the age equivalent of humans’ 80s and 90s, while others age and die much younger. In addition, scientists have identified all of the fruit fly’s genes and know how to switch individual ones on and off.

In a previous study, the UCLA researchers discovered that five or six days before flies died, their intestinal tracts became more permeable and started leaking.

In the latest research, which analyzed more than 10,000 female flies, the scientists found that they were able to detect bacterial changes in the intestine before the leaking began. As part of the study, some fruit flies were given antibiotics that significantly reduce bacterial levels in the intestine; the study found that the antibiotics prevented the age-related increase in bacteria levels and improved intestinal function during aging.

The biologists also showed that reducing bacterial levels in old flies can significantly prolong their life span.

“When we prevented the changes in the intestinal microbiota that were linked to the flies’ imminent death by feeding them antibiotics, we dramatically extended their lives and improved their health,” Walker said. (Microbiota are the bacteria and other microorganisms that are abundant in humans, other mammals, fruit flies and many other animals.)

Flies with leaky intestines that were given antibiotics lived an average of 20 days after the leaking began—a substantial part of the animal’s life span. On average, flies with leaky intestines that did not receive antibiotics died within a week.

The intestine acts as a barrier to protect our organs and tissue from environmental damage.

“The health of the intestine—in particular the maintenance of the barrier protecting the rest of the body from the contents of the gut—is very important and might break down with aging,” said Rebecca Clark, the study’s lead author. Clark was a UCLA postdoctoral scholar when the research was conducted and is now a lecturer at England’s Durham University.

The biologists collaborated with William Ja, an assistant professor at Florida’s Scripps Research Institute, and Ryuichi Yamada, a postdoctoral research associate in Ja’s laboratory, to produce an additional group of flies that were completely germ-free, with no intestinal microbes. Those flies showed a very dramatic delay in intestinal damage, and they lived for about 80 days, approximately one-and-a-half times as long as the animal’s typical life span.

Scientists have recently begun to connect a wide variety of diseases, including diabetes and Parkinson’s, among many others, to changes in the microbiota, but they do not yet know exactly what healthy microbiota look like.

“One of the big questions in the biology of aging relates to the large variation in how we age and how long we live,” said Walker, who added that scientific interest in intestinal microbes has exploded in the last five years.

When a fruit fly’s intestine begins to leak, its immune response increases substantially and chronically throughout its body. Chronic immune activation is linked with age-related diseases in people as well, Walker said.

Walker said that the study could lead to realistic ways for scientists to intervene in the aging process and delay the onset of Parkinson’s disease, Alzheimer’s disease, cancer, stroke, cardiovascular disease, diabetes and other diseases of aging—although such progress could take many years, he said.

There’s been a fast growing body of evidence in the last several years that lack of exercise – or sedentariness – is a major risk factor in health. It’s been linked to heart disease, cancer, and to an early death. And now, a new study finds that lack of exercise may actually be even more of a risk than obesity in early mortality: The researchers calculate that a sedentary lifestyle may actually confer twice the risk of death as being obese. That said, the two are both important and, luckily, closely related: So if you start getting active, you’ll probably lose a little weight along the way, which itself is a very good thing.

The new study looked at data from over 334,000 people who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Over a period of 12 years, the participants’ height, weight, and waist circumferences were tracked, along with self-reports of activity levels, both at work and in free time. All-cause mortality (i.e., death from any cause) was the main outcome of interest.

It turned out that lack of physical activity was linked to the greatest risk of death – and the greatest reduction in death risk was in the difference between the lowest two activity groups. In other words, just moving from “inactive” to “moderately inactive” showed the largest reduction in death risk, especially for normal weight people, but true for people of all body weights. And, the authors say, just taking a brisk 20-minute walk per day can move you from one category to the other, and reduce the risk of death anywhere from 16% to 30%.

Using a statistical model, the team also calculated that being sedentary may account for double the death risk of obesity. According to their math, of the 9.2 million deaths in Europe in 2008, about 337,000 were attributable to obesity, whereas 676,000 were attributable to sedentariness.

Another takeaway from the study, however, is that waist circumference is a bigger player in mortality risk than overall body weight, which has certainly been suggested by previous studies. Belly fat seems to be disproportionately linked to chronic health issues like heart disease, stroke, diabetes, cancer, and of course, early mortality. So reducing belly fat is always a significant benefit to one’s health.

“This large study is rather complex in its details, but the take-away messages are actually both clear and simple,” says David L, Katz, Director of the Yale University Prevention Research CenterGriffin Hospital. “At any given body weight, going from inactive to active can reduce the risk of premature mortality substantially. At any given level of activity, going from overweight to a more optimal weight can do the same. We have long known that not all forms of obesity are equally hazardous, and this study reaffirms that. Losing weight if you have an excess around the middle, where it is most dangerous, exerts an influence on mortality comparable to physical activity. Losing excess weight that is not associated with a high waist circumference reduces mortality risk, but less — as we would expect.”

But perhaps the main point in all of this is that being active and being a healthy weight are inextricably linked. Though activity by itself can offer an immediate health benefit if you remain overweight, getting active also leads naturally to loss of body weight. “This study reminds that being both fit and unfat are good for health,” says Katz, “and can add both life to years, and years to life. These are not really disparate challenges, since the physical activity that leads to fitness is on the short list of priorities for avoiding fatness as well. The challenge before us now is for our culture to make it easier to get there from here.”

Earlier this month a study showed that the concept of “healthy obesity” may be very misleading, since health markers in an obese person tend to deteriorate over time. Though the current study suggests that fitness may matter more than fatness, the two are really two sides of a coin: It would be silly to become active and not lose weight — and it would be very hard to do, since the one leads to the other. But perhaps given the great benefits of exercise alone, public health campaigns should focus not just on losing weight, but on encouraging people to add just small amounts physical activity to their lives right off the bat, and to see where it goes from there.

http://www.forbes.com/sites/alicegwalton/2015/01/15/is-lack-of-exercise-worse-for-your-health-than-obesity/

brain

The many documented cases of strange delusions and neurological syndromes can offer a window into how bizarre the brain can be.

It may seem that hallucinations are random images that appear to some individuals, or that delusions are thoughts that arise without purpose. However, in some cases, a specific brain pathway may create a particular image or delusion, and different people may experience the same hallucination.

In recent decades, with advances in brain science, researchers have started to unravel the causes of some of these conditions, while others have remained a mystery.

Here is a look at seven odd hallucinations, which show that anything is possible when the brain takes a break from reality.

1. Alice-in-Wonderland syndrome
This neurological syndrome is characterized by bizarre, distorted perceptions of time and space, similar to what Alice experienced in Lewis Carroll’s “Alice’s Adventures in Wonderland.”

Patients with Alice-in-Wonderland syndrome describe seeing objects or parts of their bodies as smaller or bigger than their actual sizes, or in an altered shape. These individuals may also perceive time differently.

The rare syndrome seems to be caused by some viral infections, epilepsy, migraine headaches and brain tumors. Studies have also suggested that abnormal activity in parts of the visual cortex that handle information about the shape and size of objects might cause the hallucinations.

It’s also been suggested that Carroll himself experienced the condition during migraine headaches and used them as inspiration for writing the tale of Alice’s strange dream.

English psychiatrist John Todd first described the condition in an article published in the Canadian Medical Association Journal in 1955, and that’s why the condition is also called Todd’s syndrome. However, an earlier reference to the condition appears in a 1952 article by American neurologist Caro Lippman. The doctor describes a patient who reported feeling short and wide as she walked, and referenced “Alice’s Adventures in Wonderland” to explain her body image illusions.

2. Walking Corpse Syndrome
This delusion, also called Cotard’s Syndrome, is a rare mental illness in which patients believe they are dead, are dying or have lost their internal organs.

French neurologist Jules Cotard first described the condition in 1880, finding it in a woman who had depression and also symptoms of psychosis. The patient believed she didn’t have a brain or intestines, and didn’t need to eat. She died of starvation.

Other cases of Cotard’s syndrome have been reported in people with a range of psychiatric and neurological problems, including schizophrenia, traumatic brain injury and multiple sclerosis.

In a recent case report of Cotard’s syndrome, researchers described a previously healthy 73-year-old woman who went to the emergency room insisting that she was “going to die and going to hell.” Eventually, doctors found the patient had bleeding in her brain due to a stroke. After she received treatment in the hospital, her delusion resolved within a week, according to the report published in January 2014 in the journal of Neuropsychiatry.

3. Charles Bonnet syndrome
People who have lost their sight may develop Charles Bonnet syndrome, which involves having vivid, complex visual hallucinations of things that aren’t really there.

People with this syndrome usually hallucinate people’s faces, cartoons, colored patterns and objects. It is thought the condition occurs because the brain’s visual system is no longer receiving visual information from the eye or part of the retina, and begins making up its own images.

Charles Bonnet syndrome occurs in between 10 and 40% of older adults who have significant vision loss, according to studies.

4. Clinical lycanthropy
In this extremely rare psychiatric condition, patients believe they are turning into wolves or other animals. They may perceive their own bodies differently, and insist they are growing the fur, sharp teeth and claws of a wolf.

Cases have also been reported of people with delusional beliefs about turning into dogs, pigs, frogs and snakes.

The condition usually occurs in combination with another disorder, such as schizophrenia, bipolar disorder or severe depression, according to a review study published in the March issue of the journal History of Psychiatry in 2014.

5. Capgras delusion
Patients with Capgras delusion believe that an imposter has replaced a person they feel close to, such as a friend or spouse. The delusion has been reported in patients with schizophrenia, Alzheimer’s disease, advanced Parkinson’s disease, dementia and brain lesions.

One brain imaging study suggested the condition may involve reduced neural activity in the brain system that processes information about faces and emotional responses.

6. Othello syndrome
Named after Shakespeare’s character, Othello syndrome involves a paranoid belief that the sufferer’s partner is cheating. People with this condition experience strong obsessive thoughts and may show aggression and violence.

In one recent case report, doctors described a 46-year-old married man in the African country Burkina Faso who had a stroke, which left him unable to communicate and paralyzed in half of his body. The patient gradually recovered from his paralysis and speaking problems, but developed a persistent delusional jealousy and aggression toward his wife, accusing her of cheating with an unidentified man.

7. Ekbom’s syndrome
Patients with Ekbom’s syndrome, also known as delusional parasitosis or delusional infestations, strongly believe they are infested with parasites that are crawling under their skin. Patients report sensations of itching and being bitten, and sometimes, in an effort to get rid of the pathogens, they may hurt themselves, which can result in wounds and actual infections.

It’s unknown what causes these delusions, but studies have linked the condition with structural changes in the brain, and some patients have improved when treated with antipsychotic medications.

http://www.livescience.com/46477-oddest-hallucinations.html