maeshima shinichiro

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.

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.

The prefrontal area has been once called "Silent area". However, in recent years, it has known that there are many cognitive function in the prefrontal area and it plays a very important role in order to make a living in the society for human. The damage of frontal lobe causes aphasia, unilateral spatial neglect, memory disorder, and disturbance of attention. Moreover, an execution functional disorder, social behavior disorders such as disinhibition and a personality change, and apathy are seen. In order to exam the patients with frontal lobe damage, we have to evaluate neuropsychological and psychological function in detail, based on functional anatomy and pathophysiology. The abnormality in the neuropsychological tests for the frontal lobe function does not reflect only the damage of frontal lobe specifically and the abnormal results may also cause from the damage of other part in the brain. To conduct a correct evaluation and diagnosing pathophysiology is the first step for a patient with frontal lobe damage to lead comfortable social life.