Browsing by Author "Kirshner, Howard S."
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Item Crossed aphasia - functional brain imaging with PET or SPECT(Amer Medical Assoc, 1996) Kirshner, Howard S.; Wertz, Robert T.; Bakar, Mustafa; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.Objectives: To study patients with crossed aphasia (aphasia secondary to lesions in the right hemisphere in right-handed patients) with functional brain imaging using positron emission tomography (PET) or single photon emission computed tomography (SPECT); to see whether left hemisphere structures were metabolically depressed during the acute phase and, in 1 patient, during recovery; and to review the modern literature on crossed aphasia, with special reference to left hemisphere involvement. Design: Case studies of 3 patients with crossed aphasia, including language testing, computed tomographic scanning, and functional imaging with PET or SPECT. Setting: Hospital case studies. Patients: Three-right-handed patients with crossed aphasia secondary to acute infarctions in the right hemisphere and left hemiparesis. Methods: All 3 patients were studied by means of bedside language testing, computed tomographic scanning, and functional brain imaging with PET or SPECT. Patient 1 also underwent serial testing with the Boston Diagnostic Aphasia Examination and follow-up PET scanning after 2 months of recovery. Outcome Measures: Clinical examination in all 3 patients and follow-up Boston Diagnostic Aphasia Examination and PET scanning in patient 1. Results: Two patients had severe global aphasia and 1 had Broca aphasia. In all cases, computed tomographic scans failed to reveal any left hemispheric lesions. Functional imaging with PET or SPECT showed extensive hypometabolism or hypoperfusion in the right hemisphere, with initial reductions in the left hemisphere as well. In patient 1, a follow-up PET image showed only persistent hypometabolism in the right hemisphere. Conclusions: These findings suggest that abnormal dominance for at least some language functions in the right hemisphere underlies the syndrome of crossed aphasia. Diaschisis, or functional depression of the anatomically normal left hemisphere, was seen in all 3 patients during the acute phase, but not in patient 1 after recovery had begun.Item The opercular-subopercular syndrome: four cases with review of the literature(Ios Press, 1998) Kirshner, Howard S.; Niaz, Faiz; Bakar, Mustafa; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.We present four cases of the 'opercular syndrome' of volitional paresis of the facial, lingual, and laryngeal muscles (bilateral facio-glosso-pharyngo-masticatory paresis). Case histories and CT brain images are presented, along with a review of the literature concerning this long-recognized but little-known syndrome. The neuroanatomic basis of the syndrome classically involves bilateral lesions of the frontal operculum. We propose, on the basis of our cases and others, that the identical syndrome can arise from lesions of the corticobulbar tracts, not involving the cortical operculum. Our cases included one with bilateral subcortical lesions, one with a unilateral left opercular lesion and a possible, non-visualized right hemisphere lesion, one with unilateral cortical and unilateral subcortical pathology, and one with bilateral cortical lesions. These lesion localizations suggest that any combination of cortical or subcortical lesions of the operculum or its connections on both sides of the brain can produce a syndrome indistinguishable from the classical opercular syndrome. We propose the new term 'opercular-subopercular syndrome' to encompass cases with predominantly or partially subcortical lesions.