Biomedical subjects
Publications and source records attributed to L A Vignolo.
We describe a 31-year-old man who has been living in a 'locked-in' condition for the past 12 years. Extensive testing, using both the patient's residual eye movements and a writing apparatus, showed preserved cognitive abilities in spite of the long-standing de-efferentation. The emotional consequences of this condition are discussed in relation with the results of personality testing.
The hypothesis was tested that alexia associated with Broca's aphasia may often be a residual receptive disorder of a broader picture of global aphasia. It was found that alexia does tend to be associated, as expected, to the long-standing Broca's aphasias more often than to the recent ones. However, the CT scan failed to disclose larger and more posterior lesions in Broca's alexic than in Broca's non-alexic patients.
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Two clinical-CT scan studies were undertaken in order to investigate the frequency and the characteristics of aphasia following strictly subcortical left hemisphere lesions. In Study 1, all patients whose CT scan, carried out within a given period, showed subcortical lesions in both hemispheres, were evaluated for presence and type of aphasia; conversely, in Study 2 the records of all patients referred to our Aphasia Unit for language evaluation within a given period, were examined for presence of subcortical lesions on the CT scan. In Study 1 aphasia was found in two out of six patients. In Study 2 stabilized, strictly subcortical lesions of the left hemisphere were found in six out of 250 patients referred to the Aphasia Unit; 4 out of 6 were aphasics. Closer scrutiny of the type of language disorder in the aphasics from both studies (N = 6) suggests the possibility of differentiating two types of defect: an atypical non fluent aphasia, sometimes associated with anterior capsular-putaminal lesions, and a mild fluent aphasia, sometimes associated with posterior capsular-putaminal lesions.
CT scan studies of lesion localization in aphasic patients have in general confirmed the traditional locus of damage within the left hemisphere for the major syndromes. Some interesting exceptions have come to light, such as the possible occurrence of global aphasia with a partial lesion (anterior or posterior) of the language zone. The study of correlations in vivo has underlined the importance of considering time since onset in the evaluation of the clinical picture. Description of atypical aphasias associated with subcortical lesions and correlation of lesion site with specific, partial aspects of linguistic impairment are two areas where CT scan studies are increasing our understanding of the language machinery in the brain.
Auditory agnosia can be defined as the defective recognition of non-verbal sounds and noises. The clinical picture of this disorder is described and the scarcity of knowledge of auditory agnosia derived purely from single cases is discussed. Next, experimental studies on unselected series of brain-damaged patients, especially designed to clarify the relation of auditory agnosia to aphasia and to the hemispheric locus of the lesion are reported. The results consistently point to the existence of two types of auditory agnosia, a semantic-associative one, specifically associated with lesions of the left hemisphere and aphasia, and a discriminative one, specifically associated with lesions of the right hemisphere. The hypothesis is advanced that the semantic-associative variety of auditory agnosia is part of a wider cognitive disorder.
The extent of the anterior speech region (defined as pars opercularis and pars triangularis of the third frontal convolution) and of the planum temporale was measured in 12 brains belonging to strictly right-handed persons. When the portion of the anterior speech region visible on the hemispheric surface was measured, no interhemispheric difference was found. By contrast, when both the extrasulcal and intrasulcal portions of cortex were considered, the anterior speech region in the left hemisphere was found to be significantly larger than the homologous areas in the right hemisphere. The planum temporale was significantly larger on the left than on the right, but there was no necessary correspondence between the presence of a larger right planum and a larger right anterior speech region.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
This study was undertaken in order to investigate the effects of closed head injury with coma, sustained during school age (7-14 years) on the neuropsychological performances of the subject examined at least 7 years later, in early adulthood (18-27 years). Twenty-one subjects who met these requirements were examined with neuropsychological tests, supplemented by complete neurological examinations and interviews with both the subject and at least one relative. Only 3 subjects out of 21 were found to be "impaired" from a neuropsychological point of view, since they fell below the cut-off scores in at least 4 tests out of 9. These findings suggest that the long-term prognosis of closed head injury in school-age children is generally good. The factors that may have influenced the prognosis in these patients are discussed.
The influence of language rehabilitation on specific language skills (speaking, understanding, writing, and reading) was investigated in 281 aphasic patients (162 reeducated and 119 controls) who were subjected to a second examination no less than six months after the first. The relationship of the following factors to improvement was studied: (a) time between onset of aphasia and first examination; (b) type of aphasia; (c) overall severity of aphasia on first examination; (d) presence or absence of rehabilitation between first and subsequent examination. It was found that rehabilitation has a significant positive effect on improvement in all language skills. Time between onset and first examination and overall severity of aphasia were negatively related to improvement. The relationship of type of asphasia to improvement was not significant. Additional evidence of the efficacy of rehabilitation is provided by experience with patients who began language therapy several months or years after the onset of their language disorder.
In a series of 14 thalamic hemorrhage documented by Computerized Axial Tomography (CT) scans, aphasia was present in seven out of eight patients with left lesions while it was absent in the six patients with right lesions. In three cases where detailed language testing was performed, aphasia was characterized by reduction of spontaneous speech with semantic paraphasias, preserved repetition and partially defective auditory verbal comprehension. The language disturbance was persistent in two patients, while it recovered spontaneously within four weeks in one patient. The clinical picture in these patients is similar to the classical "transcortical" aphasias, which are usually due to damage of the marginal language areas. It is suggested that the left thalamus contributes to the semantic level of verbal behavior, which is possibly subserved by these areas.
Ninety right-handed patients with present or past evidence of aphasia following a stroke were given a standard language battery and a CT scan examination. Presence and type of aphasia were correlated with the location and extent of the CT scan lesion. Most of the findings were compatible with the traditional views about the localisation of lesions in aphasia (e.g., anterior lesions in nonfluent aphasias with good comprehension, posterior lesions in fluent aphasia, etc.). The possible explanations for some unexpected findings (e.g., purely anterior lesions in global aphasia, or purely deep lesions in Broca's aphasia) are discussed. It is stressed that in establishing clinico-CT scan correlation, careful consideration must be given to the fact that both aphasia and the underlying lesion evolve with time.
A simple procedure for mapping the brain lesions observed on the CT scan sections onto a standard diagram of the cerebral hemisphere is described in detail, and its utility for neuropsychological research is briefly discussed.
Of 500 left brain-damaged patients with educational level above elementary school investigated with a standard quantitative battery for dissociation between oral and written expression, speech was found to be selectively impaired in seven (three with "pure anarthria," two with anarthria in the context of Broca's aphasia, and two with fluent aphasia with remarkable sparing of writing), and writing in another seven (two with "pure" agraphia, two with "agraphia with mild alexia," and three with "agraphia with mild fluent aphasia.") The nature of three conditions (pure anarthria, fluent aphasia with sparing of writing, and pure agraphia) is discussed, with evidence of a selective association between pure agraphia and lesions of the upper left parietal lobule.
Eight-four right-handed patients with unilateral hemispheric damage (50 aphasics, 12 non-aphasic left brain-damaged and 22 right brain-damaged patients) and 53 control patients without cerebral lesions were given a test of phoneme identification which examined the S's ability to identify the acoustic boundary between the two phonemes, /d/ and /t/, expressed in terms of voice-onset time (VOT). Phonemic identification defect (PID), defined with reference to the performance of the control group, was found to be virtually limited aphasics; in over 70 per cent of them, the identification of the boundary zone between voiced and voiceless consonants along the VOT continuum was either impossible or abnormal, While neither the fluency - nonfluency dimension of speech nor the level of comprehension seemed to be crucially associated with PID, some evidence pointed to disordered phonemic output as to one dimension of aphasia that is specifically related to it.
This study was undertaken in order to ascertain the specific effect of language rehabilitation on the oral expression of aphasic patients. The outcome of language disorders has been investigated in 185 aphasics (91 reeducated and 94 not reeducated) submitted to control examination at least 6 months following the first examination. Four of the main variables involved in the recovery process were studied: a) dependent variable, i. e., improvement, and the effects thereupon of 3 independent variables, i. e., a) the time interval between onset of aphasia and first examination, b) clinical type of aphasia on first examination and c) presence or absence of rehabilitation between first and second examination. Age, educational level, etiology and the time interval between first and second examination were controlled in all comparisons. The statistical analysis has established that language rehabilitation has a positive effect on the improvement of oral expression, while the duration of aphasia at the time of the first examination has an equally significant, but negative effect on improvement.