Radiology Picture

This 59 year-old female patient presented with acute right hemiplegia, aphasia and confusion. She had a known cerebral melanoma metastasis in the left frontal lobe. This axial T2-weighted MR (click image for arrows) shows a large haematoma with a fluid-fluid level (green arrows). There is a smaller low signal area anteriorly (red arrows) which corresponded to the known metastasis. This smaller area enhanced after gadolinium, as did the overlying dura.

Melanoma metastases may be hyperintense on T1W images and demonstrate signal loss on T2 or T2* sequences. This is due to the presence of both melanin and blood products. Melanoma metastases are 5 times more likely to show signal loss on T2* images than lung metastases, and 4.5 times more likely to be T1 hyperintense. T1 hyperintensity correlates with melanin content better than does T2* signal loss. T2* imaging (or susceptibility-weighted imaging) may be useful in screening for melanoma metastases as lesions are more conspicuous.

Reference: Gaviani P, et al. Improved Detection of Metastatic Melanoma by T2*-Weighted Imaging. American Journal of Neuroradiology 27:605-608, March 2006

Credit: Dr Laughlin Dawes

Aphasia Progress in the last quarter of a century

Argye E. Hillis, MD

From the Departments of Neurology and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, and Department of Cognitive Science, Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Dr. Argye E. Hillis, Department of Neurology, Phipps 126, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287 argye@JHMI.edu

In the last 25 years, characterization of aphasia has shifted from descriptions of the language tasks that are impaired by brain damage to identification of the disrupted cognitive processes underlying language. At the same time advances in technology, including functional imaging, electrophysiologic studies, perfusion imaging, diffusion tensor imaging, and transcranial magnetic stimulation, have led to new insights regarding the relationships between language and the brain. These insights, together with computational models of language processes, converge on the view that a given language task relies on a complex set of cognitive processes and representations carried out by an intricate network of neural regions working together. Recovery from aphasia depends on restoration of tissue function or reorganization of the cognitive/neural network underlying language, which can be facilitated by a number of diverse interventions. The original research by the author reported in this article was supported by NIH R01 DC05375.

Aphasia group a finalist in fund competition

Good Things Happening

At age 52, Johan de Roos was a picture of health last year: no high blood pressure, no signs of heart disease and a comfortable cholesterol level.

Then came a stroke and what followed was a diagnosis of aphasia, a disease neither he nor his wife, Susan, knew much about.

Aphasia, they learned, is caused by a stroke or traumatic brain injury. It damages the ability to speak and understand others, and causes difficulty with reading, writing and numbers.

The Evendale couple started an Aphasia Support Center project that has been selected as one of three from Cincinnati to make the top 50 list of the American Express Members Project, putting it in line for several million dollars.

Other local projects in the top 50 list: 50,000 Families up From Poverty and Children's Safe Drinking Water.

Susan de Roos said for years people with aphasia were given little hope for improvement beyond the first three months.

"Now we know that with continued therapy, improvement is possible," said Susan de Roos, a retired manager at General Electric, Evendale.

She said the Aphasia Support Center would provide group therapy, group activities, computer aided therapy, caregiver support and community outreach.

The 50,000 Families up From Poverty group aims to provide water to communities in India, Africa and other impoverished areas worldwide by drilling tube wells wherever needed.

The Children's Safe Drinking Water project aims to address this issue through an innovative and low-cost technology that effectively purifies and cleans water while removing bacteria, viruses and parasites.

American Express sponsors the program. Card members and the Members Project Advisory panel selected the final 50 projects from 7,000 ideas submitted.

Ideas included community-based projects throughout the United States and international aid projects in Africa and Asia.

In the next phase, cardholders will register and vote for a favorite project.

"We are encouraging all card members to make their voices heard by voting for the idea they want American Express to make a reality," said Jud Linville, president and chief executive officer of U.S. Consumer Business at American Express. "The power is in their hands."

To vote, log on to www.membersproject.com. Card members can register to vote through Aug. 5.

BIG DONORS TO UNITED WAY

Two local couples have joined 12 other couples, individuals and organizations in the United Way of Greater Cincinnati's Million Dollar Roundtable.

They are Stanley M. Chesley and his wife, Susan J. Dlott; and Jack Gluckman and his wife, Victoria Buyniski Gluckman.

Chesley, an attorney, is president of Waite, Schneider, Bayless and Chesley. His wife, Susan, is a U.S. District Court judge for the Southern District of Ohio.

Jack Gluckman is professor of otolaryngology, head and neck surgery, at the University of Cincinnati.

Victoria Gluckman is founder and CEO of United Medical Resources Inc.

IN THE BLAIR CHAIR

FORMER Prime Minister Tony Blair has no doubt left a lasting legacy during a decade in the hot seat.

Mr Blair has made tough decisions during his three terms in office and chaired challenging Cabinet meetings.

His work included the controversial decision to go to war in Iraq, constitutional reforms for Scotland and Wales, and a raft of domestic policies.

Now a Furness charity worker has had a glimpse of what it’s like being in Mr Blair’s shoes.

Retired Ulverston shopkeeper Christine Adams felt like she was PM for a day when she sat in the hot seat occupied by Mr Blair.

Mrs Adams, from Birkett Drive, also got the chance to meet Cherie Blair, wife of the Prime Minister, two weeks before her husband handed over the reins of power to Gordon Brown.

The 67-year-old grandmother is a member of a local branch of Speakability, a self help charity group which covers South Lakes, and is based in Kendal.

Speakability is involved with helping the quarter of a million people in the UK who suffer from “aphasia”, a condition which affects victims of strokes, head injuries or other neurological conditions.

And Mrs Adams was one of two members of the group lucky enough to go No 10 and raise the profile of Speakability with Cherie Blair.

Mrs Adams said: “Although we meet in Kendal we have members from all over the South Lakes. In fact our chairman, Fred Hammond, lives in Flass Lane, Barrow, and I live on Birkett Drive, in Ulverston.

“It was my speech therapist who put me in touch with them, when I had a brain aneurism and it was such a help to me I have stayed with them.

“Speakability relies on donations and we had collections in Booths’ supermarket in Windermere and Morrisons’ store in Kendal where we raised over a thousand pounds.

“Janet Rockliffe, the branch secretary, and I were lucky enough to be chosen to visit No 10 Downing Street. Names were drawn out of a hat and 45 people, including myself, were chosen.

“We were first taken through the main gate, where we had to go through security and were allowed to take photographs outside No 10. We went in three at a time to meet Cherie Blair and Lady Wilson, Harold Wilson’s widow, Mary. Cherie spoke to each of us and she was very nice. She was especially interested in Speakability as Tony’s father has aphasia and Tony is a vice-president of the charity. Cherie then came in and addressed everyone.

“We were able to look around the rooms, the dining room and the Cabinet Office where I sat in Tony Blair’s chair, and for a couple of minutes thought I was the Prime Minister!”

* Cherie Blair is featured on The Real Cherie Blair, on BBC One at 9pm tonight.
FORMER Prime Minister Tony Blair has no doubt left a lasting legacy during a decade in the hot seat.

Mr Blair has made tough decisions during his three terms in office and chaired challenging Cabinet meetings.

His work included the controversial decision to go to war in Iraq, constitutional reforms for Scotland and Wales, and a raft of domestic policies.

Now a Furness charity worker has had a glimpse of what it’s like being in Mr Blair’s shoes.

Retired Ulverston shopkeeper Christine Adams felt like she was PM for a day when she sat in the hot seat occupied by Mr Blair.

Mrs Adams, from Birkett Drive, also got the chance to meet Cherie Blair, wife of the Prime Minister, two weeks before her husband handed over the reins of power to Gordon Brown.

The 67-year-old grandmother is a member of a local branch of Speakability, a self help charity group which covers South Lakes, and is based in Kendal.

Speakability is involved with helping the quarter of a million people in the UK who suffer from “aphasia”, a condition which affects victims of strokes, head injuries or other neurological conditions.

And Mrs Adams was one of two members of the group lucky enough to go No 10 and raise the profile of Speakability with Cherie Blair.

Mrs Adams said: “Although we meet in Kendal we have members from all over the South Lakes. In fact our chairman, Fred Hammond, lives in Flass Lane, Barrow, and I live on Birkett Drive, in Ulverston.

“It was my speech therapist who put me in touch with them, when I had a brain aneurism and it was such a help to me I have stayed with them.

“Speakability relies on donations and we had collections in Booths’ supermarket in Windermere and Morrisons’ store in Kendal where we raised over a thousand pounds.

“Janet Rockliffe, the branch secretary, and I were lucky enough to be chosen to visit No 10 Downing Street. Names were drawn out of a hat and 45 people, including myself, were chosen.

“We were first taken through the main gate, where we had to go through security and were allowed to take photographs outside No 10. We went in three at a time to meet Cherie Blair and Lady Wilson, Harold Wilson’s widow, Mary. Cherie spoke to each of us and she was very nice. She was especially interested in Speakability as Tony’s father has aphasia and Tony is a vice-president of the charity. Cherie then came in and addressed everyone.

“We were able to look around the rooms, the dining room and the Cabinet Office where I sat in Tony Blair’s chair, and for a couple of minutes thought I was the Prime Minister!”

* Cherie Blair is featured on The Real Cherie Blair, on BBC One at 9pm tonight.

Aphasia Sufferer's Book Club

The website of the National Aphasia Association defines the condition as: "Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is always due to injury to the brain-most commonly from a stroke, particularly in older individuals.But brain injuries resulting in aphasia may also arise from head trauma, from brain tumors, or from infections." Victims of the disorder often lose their ability to enjoy various forms of reading that they may have once enjoyed. Book clubs for victims of the disease have been formed in several areas throughout the country.

One such book club has been founded at the Gesinger South Rehabilitation Center in Central Pennsylvania. Several types of the disorder exists and not everyone who gains the condition through a stroke will have difficulty reading.

According to Robin Petrus, the facilitator of the book club, the person with the condition retains the same personality, but difficulties expressing themselves result in ostracism. A patient suffering from the condition may hear a word and know what the word means but will not be able to make the same conclusion if it appears on the printed page.

The goal of the program is to restore the ability of the participants to read and understand a complete sentences and then to string them together into complete stroy. Petrus conceived the idea after hearing of a similar program that obtained good results in California. "I've had several patients who really enjoyed reading before their stroke and missed it a loft. So I felt it would be a good oppopurtunity for people with similar interestest to come together. The purpose of the group," Petrus stated, "Is to help people who have enjoyed reading before having aphasia to enjoy a good book again. It's therapeutic by nature."

Participants in the program not only receive a prepare guide to help them study the material and if the book on tape to help them along. According to Barbara Pizzoli, a resident of Atlas, the book club produced immediate results for her. Another participant had her ability to read and enjoy suspenseful mysteries restored. Debra Horn found it difficult to pay attention to what she read after suffering from a stroke in 1998.

In addition to restoring the ability to read and enjoy books, the program also brings together people who suffer from a similar condition. For many of them, who have difficulty getting around, it is one of the few opportunities they get to meet and interact with other people. Petrus said, "That's the key. I want this book club to help people do something they always enjoyed doing. We don't emphasize the disability. We emphasize their ability."