We describe a case of supernumerary phantom limb following focal cerebral ischaemia and discuss its neuropsychological, neurophysiopathological and neuroradiological features in light of previous data in the literature. The illusory perception of a phantom limb, seldom reported as a consequence of cerebral lesions, seems in this case to be due to the right subcortical damage altering sensory input to the higher somatosensory cortical areas involved in body image.

We have assessed 26 aphasic patients, matched in pairs as closely as possible for personal data (age, sex, education), neurological damage suffered (nature, site and size of lesions) and characteristics of linguistic impairments (type of aphasic syndrome and severity of aphasia). These patients were therefore distinguishable only by the presence (n=13) or absence (n=13) of structured, systematic language therapy. The assignment to one group or the other was not random; rather, the patients who constitute the non-rehabilitated group could not, for logistic and/or familial reasons, attend language therapy sessions. Our findings confirm the effectiveness of language rehabilitation in aphasic disorders: at the end of 6 months of therapy the number of patients who met our criterion for improvement was significantly higher in the treated group in the expressive language modality. The rehabilitated and non-rehabilitated groups did not differ significantly at 4 months post-onset, while they did differ significantly at 7 months post-onset; this shows that the duration of treatment seems to be a determining factor in the effectiveness of language rehabilitation.

We describe the case of a 56 year old female, with a history of migraine since adolescence, who experienced two episodes of transient topographical disorientation in the absence of intellectual deterioration or evident focal cerebral lesions.

The relatively few studies concerning spontaneous recovery from aphasia yield contradictory findings because of the large number of influencing factors. We have assessed a selected sample of 45 patients, none of whom received language therapy, in order to determine such patients' chances of spontaneous recovery in relation to type and severity of aphasia and size of lesion. Our results show comprehension to have the best recovery, independent of type and severity of aphasia. Expression shows a lower recovery, especially for non-fluent aphasics; their performance is also negatively influenced by oral apraxia. In addition, the overall severity of aphasia, associated with large lesions, is a negative prognostic factor for recovery of expression.

The sensitivity of the Mini-Mental State Examination (MMSE) was assessed in a sample of patients with dementia of the Alzheimer type or vascular dementia. The MMSE identified the majority of pts with diffuse cognitive impairment but did not discriminate between the two types of dementia. It failed to detect mild deterioration or forms in which only some cognitive functions were impaired. The test is therefore not sufficient for distinguishing deteriorated from non deteriorated, pts, although it is still useful in mass screening or for a quick assessment of deterioration in the course of clinical neurological examination.

A striking dissociation between the inability to identify living things plus food, along with a preserved ability to identify inanimate objects has been observed in patients who are recovering from herpes simplex encephalitis. In order to find out if a similar dissociation is also present in Alzheimer's disease (where the suspected initial site of parenchymal atrophy involves the same areas affected by herpes simplex virus), we carried out five experimental linguistic tasks to compare Alzheimer's patients' performance therein with that of vascular dementia patients and controls. Our results indicate a constant parallel between the category-specific semantic impairment of Alzheimer's patients and that described in patients recovering from herpes simplex encephalitis. The dissociation of living things+food vs inanimate objects in Alzheimer's disease appears to be of diagnostic value: it is not present in vascular dementia.

The hemiplegic patients, hospitalized for focal vascular encephalopathy, have been examined and subjected to a neurorehabilitation, in order that we could estimate the possible correlations between their response to the therapy, the presence of the deficits of superior cortical functions and the anatomic lesions which gave rise to the motor deficit. The presence of aphasia, apraxia and disorder of body image give an unfavorable influence on the response to the rehabilitative therapy, similarly as what we have observed in the patients who presented symptoms of a spread neuropsychologic compromission, correlable at CT scan with a positive result of ischemic-atrophia. The younger patients, probably better adduced reasons for the treatment and with less incidence of plurifocal lesions, show a better clinical progress.