The way to diagnose the severity of motor aphasia in ischemic brain lesion

 

The invention relates to medicine, and neurology. The patient removes the electroencephalogram (EEG). Carry out a quantitative treatment of the background EEG in the range of theta activity in the left temporal leads. Determine the absolute and relative power on the basis of which diagnose the severity of motor aphasia. The method provides an opportunity to objectively differentiated assessment of the degree of speech disorders based on the analysis of EEG data. 2 Il.

The invention relates to medicine, in particular, neurology, neurosurgery, and can be used in diagnosing the presence and severity of motor aphasia in patients with ischemic brain lesions of various origins.

There is a method of assessing the severity of aphasia (1) the nature of speech disorders. However, this method is subjective and includes mainly species identification voice of defeat. In addition, the application of the method is not able to objectively assess the degree officescape lesion that affects the choice of optimal methods of treatment, including the appointment of a course of drug therapy and the second brain in vascular pathology (2), involving the application of electroencephalography. However, the obtained data characterize mainly the volume of brain lesions and do not allow to give an objective opinion about the existence and differentiated assessment of severity of motor aphasia.

The objective of the invention is to develop a method for the diagnosis of severity of motor aphasia in ischemic brain lesion, allowing for objective differentiated assessment of the degree of speech disorders based on the analysis of electroencephalography data.

This task is solved in that in the method for the diagnosis of severity of motor aphasia in ischemic lesions of the brain, including the implementation of the EEG, quantitative processing of the background EEG performed in the range of theta activity in the left temporal leads with the definition of absolute and relative power, and when the absolute values of capacities ranging from 20 to 39 mV2when a relative is in the range from 10 to 20%, easy diagnose the severity of motor aphasia, with an absolute power in the range from 40 to 70 Áv2and relative power in the range from 21 to 30%- the th power, exceeding 30%, diagnose rough severity of motor aphasia.

The implementation of the method is illustrated by the description and example of clinical use.

The method is as follows.

Upon admission to the hospital the patient with ischemic brain examined according to standard techniques. In cases where the severity of speech disorders reliably determine fails or when possible different interpretation of the obtained data, the patient electroencephalographic examination. During electroencephalography conducted, for example, using a digital 16-channel EEG system PEGASUS (EMS, Austria) using the procedure fast Fourier transform (spectral analysis) and amplitude-frequency mapping, the patient has removed evidence of bioelectric brain activity. Quantitative processing of the background EEG performed in the range of theta activity in parts of the anterior (F7), medium (T3) and posterior (T5) temporal derivations on the left with the definition of absolute and relative power.

The choice of these leads is due to anatomical areas of the second signal system, where cortical con is svilena (abstraction F7 according to the standard scheme 1020 adopted by the method of registration of EEG). Motor analyzer written speech is located in the posterior part of middle frontal gyrus (motor area) - abstraction of T3. Visual analyzer written speech is projected in the lower parietal lobules - abstraction T5.

The data obtained are analyzed and diagnosed with some degree of motor aphasia.

So, the basis for the conclusion about the presence of mild are the absolute power of theta aktivnost on the left temporal leads in the range from 20 to 39 mV2and its relative power in the range from 10 to 20%.

When the absolute power of theta-activity in the left temporal leads in the range from 40 to 70 Áv2and relative power in the range from 21 to 30% - a moderate degree.

If the absolute power of theta activity in the left temporal leads exceed 70 Áv2and the relative power of 30%, the patient is diagnosed rough severity of motor aphasia.

Established thus the severity of motor aphasia is used as an objective criterion to assign the appropriate course of treatment.

Practical implementation of the method is illustrated by the following clinical note the physical rehabilitation of stroke in the basin of the left middle cerebral artery; mild right-sided hemiparesis.

When assessing the presence and severity of motor aphasia on traditional neuropsychological methodology, providing a 4-point assessment of the extent of damage levels, set:

1. Spontaneous speech is 3 points.

2. Automated speech - 2 points.

3. Again it is 2 points.

4. Dialogic speech - 3 credits.

5. Name - 2 points.

6. The phrase in the story the picture is 2 points.

7. Retelling texts - 2 points.

8. Understanding speech - 4 points.

9. The amount of oral-aural memory - 3 points.

10. The status of the function read - 2 points.

11. The status of the function letter 2 points.

12. The state of the oral and articulatory praxis - 3 points.

13. The state of a feature score 3 points.

The total number of points - 33; mean (arithmetic) at 2.59.

The data obtained could be interpreted as relevant at the same time moderate - II degree and lightweight - III degree officescape disorders.

To clarify the severity of aphasia, the patient underwent electroencephalography under the proposed method. In the quantitative processing of the received EEG installed on the leading temporal abstraction (F7) absolute power is a 21.5 mV2when their relative power, respectively, to 10.5, 11,6 and 13.9%. This was the basis for diagnosis in a patient with mild motor aphasia and assign the appropriate course of conservative therapy. The patient had been assigned: cardiovascular drugs - Actovegin 5 ml to 200 ml of saline intravenously 1 time per day for 10 days, Cavinton 2-4 ml per 200 ml of saline intravenously 1 time per day for 10 days, trental 5 ml in 200 ml of saline intravenously 1 time per day for 10 days; nootropics - piracetam 5 ml of 20% solution intravenously 1 time per day for 10 days; neuroprotective agents - Cerebrolysin 5 1 ml intravenously once a day for 10 days. Physiological treatments: massage, electrical stimulation of the muscles of the paretic limb, physical therapy, 10-day course of physical therapy with the use of sinusoidal modulated currents on the hyoid muscles, circular and chin facial muscles, as well as daily individual and group sessions with a speech therapist.

After treatment, significant improvement of spontaneous, recurrent, dialogical speech, volume oral-aural memory status fu is oval to dysarthria.

Example 2. Patient D., 53 years (Fig. 2), was admitted to the hospital with a diagnosis of consequences of ischemic stroke in the basin of the left middle cerebral artery; moderate right hemiparesis.

In the analysis of speech disorders, the severity of motor aphasia on traditional neuropsychological methods to reliably determine was not possible. The data obtained can be interpreted as appropriate and moderate - II degree, and rough - I severity officescape disorders. This made it difficult to assign an adequate course of rehabilitation.

According to the proposed method was performed electroencephalographically examination, which is installed on the leading temporal abstraction - F7 absolute power of theta rhythm was $ 74.1 Áv2, the average temporal - T3 - 77,6 Áv2, posterior temporo - T5 - 105,1 Áv2when their relative power, respectively, 37,1, 35,6 and 40.4%. This was the basis to diagnose the patient rough degree of motor aphasia and decision making about surgical treatment is the stimulation of cerebral blood flow by the method of distraction osteosynthesis. After this course Lecanora motor aphasia regressed to moderate.

At the control examination after 6 months, the results of treatment were fully preserved. Marked improvement in spontaneous dialogue speech, volume oral-aural memory status function of reading and writing.

Thus, using the proposed method provides an objective assessment of the severity of motor aphasia, which allows you to choose an adequate course of rehabilitation.

Sources of information

1. A standardized set of diagnostic neuropsychological methods: guidelines /Comp.: L. I. Wasserman, S. A. Dorofeeva, I. A. Meyerson, N. N. The Traugott., L., 1987.

2. Vascular diseases of the nervous system. Edited by E. C. Schmidt - Moscow, "Medicine", 1975, c.184-198.

Claims

The way to diagnose the severity of motor aphasia in ischemic brain lesion, including performing electroencephalography, characterized in that the quantitative processing of the background EEG performed in the range of theta activity in the left temporal leads with the definition of absolute and relative power, and when the absolute values of capacities ranging from 20 to 39 mV2when otnositel in the range from 40 to 70 Áv2and relative power in the range from 21 to 30% is moderate, and when values of absolute power in excess of 70 Áv2in combination with the relative capacity exceeding 30%, diagnose rough severity of motor aphasia.

 

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FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.

EFFECT: high accuracy of diagnosis.

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