Test administration intra- and postoperative

In this next part, we will have a closer look again at what happened intra and postoperatively with the tests we selected. As we saw last week, asleep-awake sedation protocol is followed. Cortical mapping with electrical stimulation at four Milliampere is performed and elicits twice speech arrest, while stimulating the motor cortex, as well as the motor response of the right hand. [NONSENSE DUTCH] This is a catox. [NONSENSE DUTCH] Catox.

Phonological paraphasia [NONSENSE DUTCH] Yes this is a Rulean

Excuse me? [NONSENSE DUTCH] Rulean

Phonological paraphasia or articulation problem That’s a harp. Yes. Cortical mapping of the temporal lobe while performing an object naming task, induces semantic paraphasias, word-finding deficits, slowness, hesitations, and some phonological paraphasias. [DUTCH:] Yes The woman

[NONSENSE DUTCH] Third man sauces

The man plays football [NONSENSE DUTCH] The man tree places [NONSENSE DUTCH] The man plantst [SIC] The tree shoots. The man … What do you call it? Those things. OK. Let’s move on.

Action naming is too difficult to administer. The patient is not able to respond within the four second time constraint of electrical stimulation. Even without electrical stimulation, the patient is not able to perform adequately on the action naming task. Besides that, phonological paraphasias and perseverations are seen. [DUTCH:] I notice that during speaking it is a lot more difficult. Yeah? Tell me. The second word I have the feeling. How am I going to do this? And in particular how do you get it out of your mouth? Yes, correct. After cortical mapping, and during resection, the spontaneous speech remains fluent and adequate. During subcortical resection, near the arcuate fasciculus, we switched to phonological tasks as repetition of words and sentences.

He makes some mistakes, but repetition stays intact. [ DUTCH:] The girl eats an apple The cook bakes a cake. The cook bakes a cake. We are dancing in the rain. We are dancing in the rain. The boy is playing outside. The boy is playing outside. We are very satisfied. We are very satisfied. The woman is sitting on the chair. The woman is sitting on the chnair [SIC]. Near the insula, our patient reports respiratory difficulty, and his speech gets incoherent and slightly disinhibited. [ DUTCH:] Actress. Actress. Musician Mutsician [SIC] Musician Musician Good. Can you still keep your eyes open? Yeah. Are you staying awake? I am listening to you, but [NONSENSE DUTCH] I can feel my ears time.

They are just closing. [NONSENSE DUTCH] Radio freak Sixty, football That’s already hard for me. Uniform. OK. The door is locked. No. The door is locked [NONSENSE DUTCH]I am just a good catch … eat with you. The last part of debulking is done while the patient performs tasks of semantic sentence judgement and phonological judgement. However, the patient fails also at these tasks, without subcortical stimulation. Conform pre-operatively. We saw those errors as false positive mapping in Week 3. No epilepsy is detected by the cortical EEG strip electrodes. [ DUTCH:] What we practised yesterday Yes. Those sentences. That’s right. You only have to say right or wrong. OK. That’s fine. Listen carefully The passenger drank a ticket. Yes, correct.

The plant laughed at the car. The plant laughed at the car. Wrong. The cat bought a new couch. Wrong The plumber is repairing the rainbow. Wrong. He finished reading the book in one go. Correct. The snail is cycling towards the bushes. [NONSENSE DUTCH] The read is cycling? The snail is cycling towards the bushes. [NONSENSE DUTCH] Yes. Correct. He can iron to there.

A paiting hangs in a museum. Correct. The butter is melting in the sun. The butter is melting in the sun. Correct. The flowers looked their eyes out. The flowers …

Correct. The flowers looked their eyes out. The flowers looked their eyes out. Correct The coffee is too hot to drink. The coffee is too hot to drink. Correct. The carpenter is buying a pack of nails. Correct. Articulation remains intact during cortical stimulation and tumour resection. Until the end of the resection, his spontaneous speech remains fluent and adequate. While the patient gets more uncomfortable and tired, and reports headache, and muscle cramps in his right leg, he receives more sedation, and gets to sleep. [DUTCH:] Is he allowed to go to sleep? Yes You can close your eyes. I will do that then. You have worked hard enough.

Now we move on to direct post-operatively assessment. Due to a generalised seizure at the end of surgery, while the patient was still in the Mayfield clamp, the patient had postoperative postictal language deficits. [DUTCH:] What is this?

Can I have a look? Yeah. This is a I just know what it is called. I just had it. So, you can do this? Yes. It is delicious. I can’t recall it. You can eat it. It is a …

I can’t recall it. Sorry. Which colour does it have?

Can you indicate that?

Brocolli. Yeah. Yeah. It is familiar to you. Can you say what this is? [NONSENSE DUTCH] [NONSENSE DUTCH] I had a stripe of that.

It is familiar. It is a heli … ? Yeah. copter. You wanted to say that “I had this in the test”? Yeah But then in black and white. Correct. You can remember that. The spontaneous speech was not fluent, and showed sound errors and creation of entirely new words, neologisms. The patient was aware of his mistakes, but unable to correct himself. In this short video clip, it is shown that a neuropsychologist administered the Montreal Cognitive Assessment, the MoCA, to screen for cognitive deficits. Also, the Aphasia Bedside Check, the ABC was administered, to screen for language deficits in the domains of production and comprehension.

Our patient also complained about visual hallucinations, or visual perceptual problems, and strange sensations in his mouth, probably epileptic. A couple of days later, the patient was tested again with the ABC and the MoCA, and showed a significant improvement of general cognitive functioning and language functions. Although he still had word finding difficulties in spontaneous speech. [DUTCH:] That is a brocolli. Very good. Delicious. That is a helicopter Can you repeat after me? Electricity. Electricity. Fine.

Job application Job application. In the next steps, we will discuss how this postoperative outcome is interpreted.