Monday, 30 March 2015

Cortical; Relapses

Puthenparampil M, Poggiali D, Causin F, Rolma G, Rinaldi F, Perini P, Gallo P.Cortical relapses in multiple sclerosis.
Mult Scler. 2015. pii: 1352458514564483. [Epub ahead of print]

BACKGROUND:Multiple sclerosis (MS) is a white and grey matter disease of the central nervous system (CNS). It is recognized that cortical damage (i.e. focal lesions and atrophy) plays a role in determining the accumulation of physical and cognitive disability that is observed in patients with progressive MS. To date, an association of cortical lesions with clinical relapses has not been described.
RESULTS: We report clinical and magnetic resonance imaging (MRI) findings of five relapsing-remitting MS (RRMS) patients who had clinical relapses characterized by the acute appearance of cortical symptoms, due to the development of large, snake-like, cortical inflammatory lesions. Symptoms were: acute Wernicke's aphasia mimicking stroke; agraphia with acalculia, not associated to a motor deficit nor linguistic disturbance; hyposthenia (weakness/lack of strength) of the left arm, followed by muscle twitching of the hand, spreading to arm and face; acute onset of left lower limb paroxysmal hypertonia (spasms/spasticity/contraction) ; and temporal lobe status epilepticus (epilepsy) , with psychotic symptoms.
CONCLUSIONS:Cortical relapses may occur in MS. MRI examination in MS should include sequences, aimed at visualizing cortical lesions, especially in the presence of symptoms of cortical dysfunction.

Receptive aphasia, also known as Wernicke’s aphasia, fluent aphasia, or sensory aphasia, is a type of aphasia traditionally associated with neurological damage to Wernicke’s area in the brain,Brodmann area 22, in the posterior part of the superior temporal gyrus of the dominant hemisphere). However, the key deficits of receptive aphasia do not come from damage to Wernicke's area; instead, most of the core difficulties are proposed to come from damage to the medial temporal lobe and underlying white matter. Wernicke's aphasia results from damage in the posterior one-third of the superior gyrus of the temporal lobe of the left hemisphere. Damage in this area not only destroys local language regions but also cuts off most of the occipital, temporal, and parietal regions from the core language region.

People with receptive aphasia are unable to understand language in its written or spoken form, and even though they can speak with normal grammar, syntax, rate, and intonation, they cannot express themselves meaningfully using language. People with Wernicke's aphasia are typically unaware of how they are speaking and do not realize it may lack meaning.

Agraphia is an acquired neurological disorder causing a loss in the ability to communicate through writing, either due to some form of motor dysfunction or an inability to spell. The loss of writing ability may present with other language or neurological disorders; disorders appearing commonly with agraphia are alexia, aphasia, dysarthria,agnosia, and apraxia.

Acalculia is an acquired impairment in which patients have difficulty performing simple mathematical tasks, such as adding, subtracting, multiplying and even simply stating which of two numbers is larger.

This study demonstrates that cognitive dysfunction may also be a relapse in MS and it is not just movement problems 

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