RESUMO

El presente trabajo tiene por objetivo principal describir los trastornos del lenguaje en el adulto a consecuencia de un daño cerebral. Las alteraciones del lenguaje oral se abordarán considerando los siguientes tópicos: Algunos conceptos lingüísticos básicos para describir con exactitud las alteraciones del lenguaje; el sistema funcional del lenguaje en el que participan áreas persilvianas, hemisferio derecho y zonas prefrontales; las afasias que son un trastorno parcial o total del lenguaje; los pacientes afásicos considerando sus antecedentes clínicos, la actitud frente al defecto, el deterioro intelectual y otros defectos asociados; el tratamiento de las afasias que tiene por objetivo que el paciente logre una comunicación funcional y una adaptación psicosocial en relación a la alteración de lenguaje y por último, los trastornos del discurso que comprometen especialmente su contenido y su uso. En relación a las alteraciones del lenguaje lectoescrito se describirán los diferentes tipos de agrafias y alexias. Finalmente, cabe señalar dos aspectos, el primero, es que además de las afasias existen otros trastornos del lenguaje y el segundo, es que la evaluación del lenguaje es fundamental para el manejo y la rehabilitación del paciente.

The main purpose of the current review is to describe the language disorders in adult as a consequence of brain damage. The oral language disorders will be approached regarding the following topics: some basic linguistic concepts to describe language disturbances accurately; the functional language system involving perisylvian areas, right hemisphere and prefrontal areas; aphasia that represent a total or partial language impairment; the patient with aphasia, regarding their clinical background, their attitude towards the alteration, the cognitive impairment and other associated disorders; the aphasia treatment which has for purposes to achieve a functional communication and psychological and social adaptation considering their language impairment and, at last, the discourse impairment which affects their use and content. Regarding the reading and writing impairment, agraphia and alexia types will be described. Finally, it is important to mention two aspects: first, besides aphasia there are other language disorders and, second, language assessment is essential to the management and rehabilitation of the patient.

Assuntos

RESUMO

We report five male patients, aged 35 to 63 years who suffered from paretic neurosyphilis. The clinical course was that of a subacute dementia with a frontal syndrome, with more apathy than euphoria. All were HIV negative and four were heterosexual. In all, the cerebrospinal fluid had a mononuclear pleocytosis and a positive VDRL. EEG was abnormal in the 3 cases in whom it was performed. One patient in whom a brain angiography was performed, had images of vasculitis. Treatment with 18-24 million units of penicillin per day during two weeks or more, was partially effective.

Assuntos

RESUMO

We report five male patients, aged 35 to 63 years who suffered from paretic neurosyphilis. The clinical course was that of a subacute dementia with a frontal syndrome, with more apathy than euphoria. All were HIV negative and four were heterosexual. In all, the cerebrospinal fluid had a mononuclear pleocytosis and a positive VDRL. EEG was abnormal in the 3 cases in whom it was performed. One patient in whom a brain angiography was performed, had images of vasculitis. Treatment with 18-24 million units of penicillin per day during two weeks or more, was partially effective.

Assuntos

RESUMO

The frontotemporal dementias are characterized by behavioral and language disorders, instead of the prominent memory loss that characterizes Alzheimer’s disease. Their loss of social intelligence, the severe apathy or des inhibition does differentiate them to the courtesy of most Alzheimer patients. Three selected cases are reported: the first one was characterized by apathy, the second by loss of the control of impulses, and the third one by complex stereotypic behavior. The diagnostic difficulty is remarked with the initial misdiagnosis in each case, and the clinical aspects are exposed.

En la clínica de las demencias frontotemporales, a diferencia de la enfermedad de Alzheimer, destacan las alteraciones de la conducta y del lenguaje y no las fallas de la memoria episódica. Todavía son poco reconocidas en nuestro medio a pesar de ser una de las 3 primeras causas de demencia degenerativa. Se presentan 3 casos seleccionados de una serie clínica: uno con apatía, otro con desinhibición y el tercero con una conducta estereotipada. Se señalan los aspectos clínicos y los errores diagnósticos cometidos en cada caso.

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RESUMO

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome, usually due to Alzheimer's disease. The first symptoms are progressive impairment of visuo spatial (Balint's and Gertsmann's syndromes) or visuo perceptive (visual agnosia, alexia) function. Episodic memory and executive function are spared until later stages. We report two males aged 51 and 55years and three females aged 50, 54 and 56 years, with posterior cortical atrophy. Ophthalmologic study was normal in all. Presenting signs and symptoms were visual ataxia, simultagnosia, agraphia, acalculia, spatial disorientation and unilateral neglect (Balint's and Gerstmann's syndromes). Apperceptive visual agnosia, aphasia, apraxia and alexia were also observed. One female had cortical blindness. Structural images were inconclusive, but PET scan and SPECT disclosed functional impairments in occipitotemporal or occipitoparietal areas.

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RESUMO

BACKGROUND: Front temporal dementias (FTD) are neurodegenerative disorders characterized by alterations in behavior, affection and language, with relative sparing of episodic memory. There are three major forms of FTD: the frontal or behavioral form, progressive non-fluent aphasia and semantic dementia (that may begin as a fluent progressive aphasia). AIM: To report a retrospective clinical experience of patients with frontotemporal dementia. MATERIAL AND METHODS: Review of 3,700 records of neuropsychological assessments of patients with behavioral disturbances, studied between 1981 and 2008. Of these, 63 patients (59% females) complied with the criteria for frontotemporal dementia. RESULTS: There were 47 cases with the frontal variant, four with non-fluent progressive aphasia and six with fluent progressive aphasias (2 evolved to semantic dementia). The mean age of onset was 60+/-11 years. There were no familiar cases of FTD. CONCLUSIONS: It is clinically difficult to diagnose FTD, since evaluation of attitude or language is required. In addition to structural images, functional images were helpful in some cases, but the definitive diagnosis is anatomical.

Assuntos

RESUMO

Background: Front temporal dementias (FTD) are neurodegenerative disorders characterized by alterations in behavior, affection and language, with relative sparing of episodic memory. There are three major forms of FTD: the frontal or behavioral form, progressive non-fluent aphasia and semantic dementia (that may begin as a fluent progressive aphasia). Aim: To report a retrospective clinical experience of patients with frontotemporal dementia. Material and methods: Review of 3,700 records of neuropsychological assessments of patients with behavioral disturbances, studied between 1981 and 2008. Of these, 63 patients (59 percent females) complied with the criteria for frontotemporal dementia. Results: There were 47 cases with the frontal variant, four with non-fluent progressive aphasia and six with fluent progressive aphasias (2 evolved to semantic dementia). The mean age of onset was 60±11 years. There were no familiar cases of FTD. Conclusions: It is clinically difficult to diagnose FTD, since evaluation of attitude or language is required. In addition to structural images, functional images were helpful in some cases, but the definitive diagnosis is anatomical.

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The pharmacological interventions for Alzheimer disease should be based in its pathogenic mechanisms such as amyloidogenesis, tau hyperphosphorilation, disturbances in neurotransmission and changes in neuronal trophism. Other therapies derive from epidemiological observations, such as antioxidants and anti-inflammatory drugs, estrogens, statins and anti hypertensive drugs. Some life style interventions, such as changes in diet, exercise and brain stimulation could also be beneficial for the prevention of Alzheimer disease. Ongoing research on pathogenic mechanisms promises the discovery of more effective therapies. Healthy life style should always be recommended due to its benefit and lack of untoward effects.

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RESUMO

Las variantes de las demencias frontotemporales son la variante frontal (VF), la afasia progresiva no fluente (APnF) y la demencia semßntica (DS), que se inicia como afasia progresiva fluente (APF). En una serie de 40 pacientes con estudio clínico e imagenológico encontramos 31 casos VF, 6 casos APF y 3 APnF. El lenguaje de los casos VF sólo a veces fue normal; se caracterizaba por ser poco informativo y poco fluente, con reducción de las ideas atingentes y aparición de ideas no atingentes o perseverativas. Diecisiete eran afßsicosy2/3 tenían defectos de comprensión. Su actitud era inadecuada, con demencia severa, apatía o euforia. En los grupos APF y APnF el iiscurso era relativamente informativo; la demencia era menos severa y la actitud mßs comprensible (ansiedad) que en el grupo VF. La fluidez diferenciaba esos grupos. Sólo en 2 sujetos del grupo APF se comprobó un defecto semßntico no verbal que permitió diagnosticarlos como DS. Se plantea que en la VF, a diferencia de la enfermedad de Alzheimer, existe una pérdida del interés comunicativo y del darse cuenta de la actitud del otro.

Frontotemporal dementia has 3 variants: frontal or behavioral (VF), progressive non fluent aphasia (APnF) and semantic dementia (DS). This one frequently starts as a progressive fluent aphasia (APF). In a series of 40 patients with clinical and brain imaging we found 31 VF, 6 APF and only 3 APnF cases. The oral language in VF patients was usually abnormal, non fluent and non informative; the number of ideas was reduced and some of them were out of context. Seventeen out of 31 VF had aphasia, and the deficit of oral comprehension was frequent. Their attitude was unusual, with severe dementia, apathy or euphoria. In groups APnF and APF the speech was fairly informative, dementia was less severe and their attitude (anxiety) more understandable than in the group VF. Fluency differentiates these groups. Only 2 subjects in the group APF had a nonverbal semantic defect that led to the diagnosis ofSD. We conclude that in the VF, unlike the usual Alzheimer's disease, there is a loss of interest in the communication and in realize the attitude of the other.

Assuntos

RESUMO

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome, usually due to Alzheimer's disease. The first symptoms are progressive impairment of visuo spatial (Balint's and Gertsmann's syndromes) or visuo perceptive (visual agnosia, alexia) function. Episodic memory and executive function are spared until later stages. We report two males aged 51 and 55years and three females aged 50, 54 and 56 years, with posterior cortical atrophy. Ophthalmologic study was normal in all. Presenting signs and symptoms were visual ataxia, simultagnosia, agraphia, acalculia, spatial disorientation and unilateral neglect (Balint's and Gerstmann's syndromes). Apperceptive visual agnosia, aphasia, apraxia and alexia were also observed. One female had cortical blindness. Structural images were inconclusive, but PET scan and SPECT disclosed functional impairments in occipitotemporal or occipitoparietal areas.

Assuntos