LANGUAGE IN INDIA

Strength for Today and Bright Hope for Tomorrow

Volume 14:12 December 2014
ISSN 1930-2940

Managing Editor: M. S. Thirumalai, Ph.D.
Editors: B. Mallikarjun, Ph.D.
         Sam Mohanlal, Ph.D.
         B. A. Sharada, Ph.D.
         A. R. Fatihi, Ph.D.
         Lakhan Gusain, Ph.D.
         Jennifer Marie Bayer, Ph.D.
         S. M. Ravichandran, Ph.D.
         G. Baskaran, Ph.D.
         L. Ramamoorthy, Ph.D.
         C. Subburaman, Ph.D. (Economics)
         N. Nadaraja Pillai, Ph.D.
Assistant Managing Editor: Swarna Thirumalai, M.A.

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Speech-language Profile, Neurological Findings and Recovery Patterns
Associated with Cerebrovenous Sinus Thrombosis

Dr. Vandana.V.P

Abstract

Cerebrovenous sinus thrombosis (CVT) is a rare neurological condition which is difficult to diagnose because of the varied neurological presentation. The pattern of speech-language findings and recovery patterns in CVT can be quite different from those seen associated with arterial stroke. In converse to arterial stroke, scarce information exists on the natural history and long-term prognosis of CVT. This is particularly true with respect to the pattern of speech and language deficits associated with this condition.The present study profiles the speech-language and recovery patterns in seven patients with cerebrovenous sinus thrombosis.

Key words: Speech-language, neurological, recovery, cerebrovenous sinus thrombosis

Introduction

Cerebro venous sinus thrombosis (CVT) is a rare and potentially deadly condition. Known conditions that increase the risk of CVT include hypercoagulable states, dehydration, adjacent infectious processes, low cerebral blood flow, oral contraceptives, hormone replacement therapy, pregnancy, and puerperium. Each of these conditions is associated with a higher risk of venous thrombus formation, but exactly why the cerebral venous sinus system is involved over other veins is unclear [1]. Diagnosis is difficult because of various and nonspecific clinical presentations. However, diagnosis must be established quickly inorder to start anticoagulant treatment as early as possible. CVT is an infrequent condition that is extremely variable in its clinical presentation, mode of onset, imaging appearance, and outcome.

In contrast to the arterial stroke, which can be easily diagnosed clinically in majority of cases, CVT has no single pattern of presentation and it may be difficult to diagnose it on clinical grounds alone [2]. Clinical presentation may be acute (within 48 hrs), subacute (bt. 2 days and one month) and chronic (>30days). Subacute or chronic presentation are commoner than in arterial stroke and progress in gradual or stepwise fashion is common. When draining venous sinuses are occluded pressure must build up in feeding arteries to maintain perfusion and this results in oedema, infarct and haemorrhage leading to different focal neurological signs like hemiparesis, aphasia, ataxia, hemianopia, neglect etc. Haemorrhage may be bilateral if obstruction is in Superior sagittal sinus (SSS). Clinical profile is determined by a) underlying sinus/ venous system involved; b) mode of onset, i.e., acute, subacute or chronic; c) time interval between onset of disease and clinical presentation; d) nature of primary disease giving rise to CVT. Cortical deficits like aphasia, agnosia, apraxia, and cortical blindness are not uncommon but are fleeting in nature.

Speech disturbance has been mentioned in superior sagittal sinus thrombosis with a small venous infarct [3], occlusions of the lateral sinus present usually as an isolated intracranial hypertension, associated with aphasia when the left transverse sinus is occluded [4], sigmoid sinus thrombosis presenting with posterior alexia [5], neurological impairments such as limb paralysis and language disorders may or may not be present [6], acute micrographia and hypophonia as the sole manifestations of extensive deep venous sinus thrombosis [7], slurred speech and right sided clumsiness [8] slurring of speech, hoarseness, nasal twang of voice and difficulty in swallowing with nasal regurgitation, difficulty in moving tongue side-to-side, arching of palate to left side, reduced palatal movements on right side, tongue deviation to right side, tinnitus of two weeks and unilateral hearing problem [9], neurological deterioration with right hemiparesis, dysarthria, global aphasia, and depressed levels of consciousness [10]. Few studies have looked at the long-term speech and language outcomes in patients with CVT. Studies using various neuropsychological batteries aimed at assessing long-term cognitive outcome have reported cognitive impairment in approximately 35% of the patients in different cohorts usually in the form of non-fluent aphasia, working memory deficits and depression [11,12].

This is only the beginning part of the article. PLEASE CLICK HERE TO READ THE ENTIRE ARTICLE IN PRINTER-FRIENDLY VERSION.

Dr. Vandana.V.P
Assistant Professor of Speech Pathology and Audiology
Department of Speech Pathology and Audiology
NIMHANS
Bangalore-29
Karnataka
India
vpvandana@gmail.com
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