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PubMed1980

[Crossed aphasia in right-handed persons].

Two cases of crossed aphasia in dextrals are presented. Twenty six cases of crossed aphasia in dextrals are reviewed, and compared with a group of aphasics by left-sided lesions. This analysis is made attending to the clinical typology of aphasia, sex, age, associated higher cortical functions defects and familial left-handedness. Crossed aphasia in dextrals is due to right or bilateral language representation. It is concluded that anomalous language is accompanied by lesser intrahemispheric specialization of the classic areas of language. The dominance of the minor hemisphere for some praxic and visuo-spatial functions is also lessened. Crossed aphasia and familial left handedness would not be associated.

Adult↗
PubMed1984

[Aphasia: causes, age distribution and hearing function].

Among 1138 aphasic patients we found that in 86% of the cases, aphasia was caused by a cerebro-vascular disease. The maximum rate of the disease occurred in patients between 70 and 79 years of age. In a random test that included 100 adult patients afflicted with aphasia (average age 64 years), 41 patients (= 41%) showed a sensory-neural hearing impairment in the tonal audiogram. Among these 41 cases, 7 patients were afflicted with a none-sided sensory-neural hearing impairment. 8 patients had already used a hearing aid prior to the onset of aphasia, or received a hearing aid after the onset of aphasiy, respectively. An additional undetected impairment of hearing function should always be considered in differential diagnosis in patients suffering from aphasia. This is of special significance in sensorial aphasis (Wernicke Aphasias). Otologists and speech therapists should regard the increasing occurrence of sensory-neural hearing impairments as an indication to pay attention to the diagnosis of hearing function and to the proper adjustment of hearing aids in this group of patients which is becoming increasingly important.

Adolescent↗
PubMed1993

[Aphasia following apoplexy. Frequency, remission and effect of treatment].

About one fourth of the patients affected by apoplexy develop an aphasic speech defect. The greater proportion of recovery occurs within the first three months after the apoplectic insult. The remainder of the recovery usually occurs in the subsequent three months and this, as a rule, is limited. According to the majority of investigations, significant improvement in speech is relatively rare after six months. The severity of the aphasia is closely connected with the degree of severity of the apoplexy. Patients with severe apoplexy and severe aphasia have poorer prognoses than patients with mild apoplexy and mild aphasia. Patients with severe aphasia also recover more slowly than patients with mild aphasia. The tendency to recover is independent of sex. It is uncertain whether age plays a part in recovery. The greater proportion of recovery is spontaneous. It is uncertain whether speech therapy affects recovery at all. The two randomised investigations which have hitherto been published have contradictory results. Four randomised investigations in which speech therapy was compared with supportive non-speech therapy provided by a volunteer (eg an interested relative or friend with training in speech therapy) show unequivocally that recovery is independent of whether treatment is provided by a speech therapist or by volunteer. The therapeutic possibilities which are offered to victims of apoplexy at present are not satisfactory. New approaches and new developments are required in this field.

Aphasia↗
PubMed1984

Age and type of crossed aphasia in dextrals due to stroke.

Thirty-nine cases (37 from the literature and 2 personal) of crossed aphasia in dextrals due to stroke were reviewed concerning age, sex, and type of aphasia. Results showed that Broca's aphasics are younger than the remaining group, males predominate, and several types of aphasia have been described similarly to the aphasias due to left-hemisphere lesions in dextrals.

Age Factors↗
PubMed1988

Perception and production of tone in aphasia.

An acoustical and perceptual study of lexical tone was conducted to evaluate the extent and nature of tonal disruption in aphasia. The language under investigation was Thai, a tone language which has five lexical tones--mid, low, falling, high, and rising. Subjects included six left brain-damaged aphasics (two Broca's, one transcortical motor, one global, one conduction, one Wernicke), one right brain-damaged nonaphasic, one cerebellar dysarthric, and five normals. High-quality tape recordings of each subject's productions of a minimal set of five, monosyllabic Thai words were presented to 10 adult Thai listeners for identification. Results from the phonemic identification tests indicated that tone production is relatively spared in aphasic patients with unilateral left hemisphere lesions. The performance of the global aphasic, however, was considerably below normal. Patterns of tonal confusions further revealed that the performance of all aphasics, except the global, differed from that of normal speakers primarily in degree rather than in kind. Tonal contrasts were signaled at a high level of proficiency by the right brain-damaged and dysarthric patients. Acoustical analysis revealed that F0 contours associated with the five tones for all aphasics, except the global, were similar in overall shape as well as position in the tone space to those of normals. F0 contours for the right brain-damaged patient and the dysarthric also generally agreed with those of normals in terms of shape and position. F0 ranges of both aphasic and nonaphasic brain-damaged speakers were generally larger than those of normals for all five tones. The relationship between tone and vowel duration was generally similar to that of normals for all brain-damaged speakers. A comparison of aphasics' performance on tone perception (J. Gandour & R. Dardarananda, 1983, Brain and Language, 18, 94-114) and tone production indicated that, for the normal and right brain-damaged subjects, performance on the perception task was higher than on production, whereas the opposite was true for the aphasics. These data are brought to bear on issues related to tone production in aphasia, consonant and vowel production in aphasia, hemispheric specialization for tone production, intonation production in aphasia, relationship between speech perception and speech production, and tone production in dysarthria with cerebellar disease.

Adult↗
PubMed1981

Dichotic ear preference for C-V-C words in Wernicke's and Broca's aphasias.

A dichotic listening task was administered to subjects with a relatively distinct Broca's aphasia, subjects with a relatively distinct Wernicke's aphasia, and normal subjects. The dichotic stimuli consisted of C-V-C words differing in initial consonant only. Subjects were instructed to respond only to the stimulus of which they were most sure by pointing to a picture representing the dichotic stimuli or foils. while normal subjects demonstrated the usual right ear effect, both the Broca's and Wernicke's aphasia groups demonstrated left ear effects. One salient explanation for these results was that any severe defect in the language systems of the left hemisphere affects the way that the left hemisphere processes linguistic information. It was postulated that left ear stimuli, which arrive at the left hemisphere later, disrupt the processing of right ear stimuli in subjects with aphasia. However, a more definitive explanation requires further research.

Adult↗
PubMed1981

Intelligence and left hemisphere disease. The role of aphasia, apraxia and size of lesion.

The Raven Progressive Matrices and four subtests of the Wechsler-Bellevue Performance Scale were given to 173 left hemisphere patients subdivided according to presence/absence, type (fluent/non-fluent) and severity (moderate/severe) of aphasia. Constructive and ideomotor apraxia scores and CT scan data of each subject entered the statistical analysis. Factors significant in producing a low score on Progressive Matrices and Wechsler-Bellevue were presence of aphasia and constructive apraxia. Site and size of lesion per se failed to account for the intelligence scores. The relationship between aphasia, apraxia, intelligence test scores, and CT scan data were discussed in an attempt to clarify the meaning of these low intelligence test scores in aphasics and to assess the underlying roles of the brain lesions in this deficit. It appears that there are a number of methodological difficulties complicating interpretation of the intellectual deficit based on the Progressive Matrices and Wechsler-Bellevue scores, since performance on these tests is adversely affected by both aphasia and apraxia.

Aphasia↗
PubMed1986

Aphasia after stroke: natural history and associated deficits.

Data relating to 976 patients registered as suffering an acute stroke has been analysed to determine the natural history of speech disturbance: these patients came from a community survey of 215,000 people over a 28 month period. Of the 545 patients assessed within 7 days of stroke, 24% were aphasic and 28% unassessable. At 3 weeks, when over 90% of survivors were tested, 20% of those tested had aphasia. At 6 months only 12% of survivors had significant aphasia, but 44% of patients and 57% of carers thought speech was abnormal. Of those aphasic within 7 days, 40% remained so at 6 months; 60% of those aphasic at 3 weeks remained so. There was a high correlation between early and late aphasia scores. Aphasia was associated with more severe disability (degree of limb weakness, loss of function, loss of IQ), and with a less good recovery of social activities, but did not cause any measurable increase in stress upon carers. In a Health District of 250,000 people, about 60 patients each year may be referred for speech therapy after an acute stroke.

Acute Disease↗
PubMed2005

Recovery from aphasia after hemicraniectomy for infarction of the speech-dominant hemisphere.

BACKGROUND AND PURPOSE: The space-occupying effect of cerebral edema limits survival chances of patients with severe ischemic stroke. Besides conventional therapies to reduce intracranial pressure, hemicraniectomy can be considered as a therapeutic option after space-occupying cerebral infarction. There is controversy regarding the use of this method in patients with infarction of the speech-dominant hemisphere. METHODS: In 14 patients with infarction of the dominant hemisphere and subsequent treatment with hemicraniectomy, recovery from aphasic symptoms was evaluated retrospectively. A group of patients who were treated between 1994 and 2003 in our aphasia ward was selected for the study. In all patients, a psychometric quantification was accomplished applying the Aachen Aphasia Test at least twice within a mean observation period of 470 days. RESULTS: A significant improvement of the statistical parameters representing different aspects of aphasia was observed in 13 of 14 patients. Also, an increase of the ability to communicate was evident in 13 patients. Young age at the time of stroke and early poststroke decompressive surgery were identified as main predictors for recovery from aphasia. CONCLUSIONS: A significant improvement of aphasic symptoms can be observed in a preselected group of patients after a massive stroke of the speech-dominant hemisphere treated by consecutive hemicraniectomy. Therefore, decompressive surgery can be considered for the treatment of this kind of stroke.

Adult↗
PubMed1987

Epilepsy-aphasia syndrome in children: an unusual presentation to psychiatry.

This paper describes the psychiatric and clinical manifestations of the epilepsy-aphasia syndrome which occurs in children. In 1957, Landau and Kleffner reported the development of receptive and expressive aphasia at 5 to 6 years of age, in six children with normal language development at that time. Since this first report, further accounts of acquired language disabilities associated with EEG abnormalities have appeared. However, the clinical syndrome remains ill defined and its pathophysiology is poorly understood. There are no reported cases of this syndrome presenting initially to psychiatry. This paper reports a child who presented to psychiatry with severe aggression associated with the clinical syndrome of epilepsy-aphasia. The discussion examines the relationships between the aggressive behavior and the EEG findings and aphasia.

Aphasia↗
PubMedDate not supplied

[The origins of language: an analysis from the aphasia perspective].

INTRODUCTION: Different areas of knowledge have contributed to a better understanding of the origins of human language. AIM. To relate our current knowledge about the origins of language with the language pathology found in the case of brain injuries (aphasia). DEVELOPMENT: There are two fundamental forms of aphasia, which linked to defects in the lexico-semantic and grammatical systems of language (Wernicke-type aphasia and Broca-type aphasia, respectively). From observations made on children's development of language and experiments with primates, it has been shown that language initially appears as a lexico-semantic system. Grammar correlates with the ability to represent actions (verbs) and depends on what is known as Broca's area and its related brain circuits, but it is also related to the ability to quickly carry out the sequencing of the articulatory movements required for speaking (speech praxis). CONCLUSIONS: Language may have appeared as a lexico-semantic system much earlier than language as a syntactic system. The former may have developed around 200,000-300,000 years ago, coinciding with the increase in the temporal lobe, and would have existed in other hominids. Language as a grammatical system appeared perhaps as recently as 50,000 years ago and seems to be exclusive to Homo sapiens.

Animal Communication↗
PubMed1989

[Current problems in the study of aphasia].

In the introductory part of the present survey the author provides a sketchy illustration of the main anatomo-clinical aspects of aphasia, focusing attention on the main patterns of language impairment and on the corresponding cortical localizations usually observed in patients with cerebro-vascular disorders of ischemic nature. In the second part of the paper, some more recent aspects of aphasiology (namely the subcortical aphasias and the so called slowly progressive aphasia) are shortly discussed. As for the first point, it is suggested that language disorders observed in patients with purely subcortical lesions may be due to a remote effect of these lesions at the level of the cortical association areas, rather than to the subcortical injury per se. As for the second point it is still not clear if the slowly progressive aphasia is a disease or a syndrome resulting from the selective affinity for the posterior association areas of the left hemisphere of degenerative disorders, such as Pick's or Alzheimer's disease.

Aphasia↗
PubMed1985

Type of aphasia: relationship to age, sex, previous risk factors, and outcome of rehabilitation.

Relationship of types of aphasia in hemiplegics to survival, outcome of rehabilitation, activities of daily living (ADL) and pre-existing risk factors, hypertension (HT), ischemic heart disease (IHD), diabetes mellitus (DM) were studied in a group of 257 patients. The control group was a large population of CVA cases previously documented. Four main categories were considered: expressive-receptive (global), predominantly expressive (Broca), predominantly receptive (Wernicke) and predominantly amnestic (anomia) aphasias. 40% of each category were female. No clear pattern emerged concerning relationship with risk factors; however, hypertension, the factor most frequently encountered, was significantly less prevalent among expressive ahphasics, and diabetes mellitus was rare among those with the receptive pattern. For all categories, the most frequent etiology was thrombosis, the second being embolia. The oldest groups were the expressive-receptive and the predominantly receptive aphasia groups: showed the poorest rehabilitation outcome in both ADL and locomotion, and lived less time after stroke (5.8 years). Amnestic and expressive patients were younger and fared better in all other parameters; an etiology of embolia was much more frequent among the former. It can be said that patients with the expressive-receptive kind of aphasia have the worst survival and rehabilitation prognoses.

Activities of Daily Living↗
PubMed2002

Nonconvulsive status epilepticus presenting as a subacute progressive aphasia.

We report a 62-year-old man with non-convulsive status epilepticus (NCSE) presenting as a progressive aphasia that developed insidiously over 5 weeks. On video-EEG monitoring, aggravation of the aphasia coincided with occurrence of seizure activities arising from the left fronto-temporal area. Brain MRI was noncontributory but a fluorodeoxyglucose-PET scan revealed a hypometabolism in the left anterior temporal area. Following anticonvulsant treatment, aphasia recovered gradually over several weeks despite prompt resolution of epileptic discharges on EEG. Our patient's findings, gradual onset of isolated aphasia with gradual resolution after initiation of treatment, may differ from previously reported cases with aphasic status epilepticus because their aphasia showed abrupt onset and rapid resolution with anticonvulsant medication.

Brain↗
PubMedDate not supplied

Cortical activation and language task difficulty in aphasia.

BACKGROUND: Previous research using functional MRI (fMRI) suggests changes in cortical activation as a function of increased task difficulty. This relationship has not been explored in persons with aphasia even though it may have significant implications for pre- and post-treatment interpretation of fMRI data. AIMS: The purpose of this exploratory study was to investigate the relationship between changes in language task difficulty and cortical activation in persons with aphasia. METHODS #ENTITYSTARTX00026; PROCEDURES: Four persons with chronic anomic or Broca's aphasia and four matched control participants underwent fMRI while performing a picture-word matching task. OUTCOMES #ENTITYSTARTX00026; RESULTS: Compared to the more difficult task condition, all participants performed with greater accuracy on the easier condition. Moreover, greater mean blood oxygenated level dependent (BOLD) signal intensity and area recruitment were noted during the more difficult condition for three out of four persons with aphasia as well as three of the four controls. The increase in cortical activity was mainly noted in the superior temporal and posterior inferior frontal lobes. CONCLUSIONS: The present findings mirror those found in previous studies of normal subjects in that cortical activation increased in parallel to task difficulty for most of our participants. It is unclear what mechanism accounts for this effect; this phenomenon might need to be considered in future fMRI studies of neural plasticity associated with aphasia treatment.

Journal Article↗
PubMed1999

Conduction aphasia and the arcuate fasciculus: A reexamination of the Wernicke-Geschwind model.

Wernicke, and later Geschwind, posited that the critical lesion in conduction aphasia is in the dominant hemisphere's arcuate fasciculus. This white matter pathway was thought to connect the anterior language production areas with the posterior language areas that contain auditory memories of words (a phonological lexicon). Alternatively, conduction aphasia might be induced by cortical dysfunction, which impairs the phonological output lexicon. We observed an epileptic patient who, during cortical stimulation of her posterior superior temporal gyrus, demonstrated frequent phonemic paraphasias, decreased repetition of words, and yet had intact semantic knowledge, a pattern consistent with conduction aphasia. These findings suggest that cortical dysfunction alone may induce conduction aphasia.

Aphasia, Conduction↗
PubMed1995

Aphasia and infarction of the posterior cerebral artery territory.

Spoken language disorders are rarely mentioned in superficial infarction of the posterior cerebral (PCA) territory. Two clinical types have been reported: transcortical sensory and amnesic aphasia. Between 1979 and 1990, we studied retrospectively 76 patients suffering from an occipitotemporal infarction located in the superficial territory of the posterior cerebral artery, all well documented by CT. Aphasia was one of the first and prominent signs in 18 cases. Middle cerebral artery concomitant infarction could have been the cause of language impairment in 10. In 8 patients aphasia was only explained by a PCA territory infarct. Three patients showed features of transcortical sensory aphasia. CT localization showed internal lobe and thalamic involvement of the dominant hemisphere. Five patients exhibited word finding impairment with various degrees of amnestic syndrome. The dominant internal temporal lobe was always affected. Dominant thalamus involvement was found in one case only. Some correlations between clinical features and anatomical support (vascular supply and anatomical structure) might be suggested in our 8 cases of aphasic disorders due to PCA infarcts. They are discussed and compared with data in the literature.

Adult↗
PubMed1983

Crossed aphasia in dextrals: a case report with special reference to site of lesion.

A strictly right-handed man showed aphasia and left hemiplegia following a deep infarct of the right hemisphere. Aphasic semeiology was characterized by an oral and written jargon while comprehension was almost intact. Several hypotheses previously put forward fail to account for the patient's aphasia. Emphasizing the frequency of deep structures involvement in the published cass of crossed dextral aphasias, it is suggested that site of lesion may have a certain part to play in the occurrence of such aphasias.

Aphasia↗