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Aphasia after stroke: a detailed study of recovery in the first 3 months.

This is a prospective study of recovery of aphasia in 19 stroke patients selected from 117 consecutive hospital admissions by virtue of having significant aphasia and surviving 13 weeks. Aphasia was measured using the Frenchay Aphasia Screening Test (FAST) at frequent intervals from early after stroke. A wide variation in speed and extent of recovery was seen, particularly when compared with mean scores. Patients who made the most recovery had started to improve by 40 days post-stroke. An aphasic patient's FAST score at 13 weeks post-stroke could be predicted from his first score (within 2 weeks).

Adult↗

Frenchay Aphasia Screening Test: validity and comparability.

The Frenchay Aphasia Screening Test1 is a reliable test which can be used by non-specialists to discriminate between aphasia and normal language. Preliminary studies have shown good test-retest reliability, and the test itself is quick and simple to use. The present investigation examines the validity of the test by comparing the results of this test with those on more structured, detailed and frequently used assessments of aphasia -the Minnesota Test for Differential Diagnosis of Aphasia (MTDDA) and general performance in communication as reflected by the Functional Communication Profile. The results demonstrate a positive correlation between the tests, and this allows confidence in the use of this test by non-specialists as a screening instrument.

Aged↗

Drawing to communicate: a case report of an adult with global aphasia.

Treatment for adults with global aphasia has typically involved the use of verbal treatment methods or alternative communication techniques including communication boards, word lists and notebooks. However, many adults with aphasia are unable to communicate verbally and alternative communication techniques can be limited, as a result of the restricted number and type of concepts that can be adequately depicted and expressed. Another viable means of communication for the globally aphasic adult is drawing. However, few individuals with severe aphasia initiate communication through this modality without specific training. In this case report we present several successful treatment methods that were used to train an adult with global aphasia to communicate more effectively through drawing. Several of his drawings are presented to illustrate the results of training in the use of drawing as an alternative means of communication.

Aphasia↗

Global aphasia due to left thalamic hemorrhage.

Global aphasia is an acquired language disorder characterized by severe impairments in all modalities of language. The specific sites of injury commonly include Wernike's and Broca's areas and result from large strokes--particularly those involving the internal carotid or middle cerebral arteries. Rarely, deep subcortical lesions may cause global aphasia. We present three cases with global aphasia due to a more rare cause: left thalamic hemorrhage. Their common feature was the large size of the hemorrhage and its extension to the third ventricule. HMPAO-SPECT in one of the cases revealed ipsilateral subcortical, frontotemporal cortical and right frontal cortical hypoperfusion. Left thalamic hemorrhage should be considered in the differential diagnosis of global aphasia.

Aged↗

[Aphasia: debates].

Quarrels over aphasia are no recent phenomena and have not always been explicit. Lordat and Gall can be cited in this respect as well as Dax and Bouillaud. Reference is also made to Broca-Dax and Trousseau-Lordat. The creation of the Chair in honour of Charcot, which contributed so greatly (thanks to Charcot himself, the others Masters and their students) to the birth of neurology, then to that of the neurological sciences and eventually to that of the neurocognitive sciences. Next, the most explicit of quarrels on aphasia is dealt with, namely that in which, during three meetings of the French Society of Neurology in 1908, Joseph Jules Dejerine and Pierre Marie crossed swords. Their duel in the Bois de Boulogne in 1893 having fortunately been cancelled, it was in 1908 merely a battle of words. Fulgence Raymond was soon to retire. Dejerine and Pierre Marie each put forward their proposal to the Society for a discussion program and Dejerine's was accepted following a vote. The meeting on 11th June, in accordance with the program proposed by Dejerine, was largely restricted to clinical facts. Fulgence Raymond was not present. Dejerine always spoke first, but some of the replies from Pierre Marie received a degree of approval from the audience. It was during this meeting that Achille Souques, the future founder of the history of neurology, cleverly defended the ideas of Pierre Marie. A little later, Dejerine went on the defensive and agreed to a change in the program along the lines suggested by Pierre Marie: he then presented his ideas on the manifest clinical difference between Broca's aphasia and that of Wernicke. After Souques, Edouard Brissaud also came to the rescue of Pierre Marie by mentioning the Leborgne case published by Broca in the spring 1861. Matters were unresolved and André-Thomas, the future founder of neuropaediatrics, produced a highly intelligent deference of his Master Dejerine. Gilbert Ballet and Ernest Dupré also came down largely on his side. The meeting of 9th July (27th anniversary of the Charcot Chair) was dedicated to cerebral anatomy and the "quadrilateral". The subject of Dejerine's questionnaire was again raised. Accompanied by Georges Guillain, Fulgence Raymond was present on this occasion (but refrained from speaking). This time the star was Augusta Dejerine Klumpke, born on a Spanish sand dune now known as San Francisco, U.S.A. Mrs Dejerine contested the "lenticular zone" and gave it a quite different dimension by proving that its anterodorsal part included associative axons originating in or projecting to Broca's area, the remainder of the "Pierre Marie quadrilateral" being called into question. Brissaud was impressed by the performance of Madame Dejerine, and Pierre Marie found himself in an awkward position. His student François Moutier, present at his request, discussed his own clinical cases and then, on the subject of "Lelong's" brain' (autumn 1861), let it be known that Broca had scratched it with his finger nails while removing the meninges. André-Thomas and Georges Guillain took part in the discussion. At the last meeting, on 23rd July, Brissaud was absent. Fulgence Raymond was again present but remained silent. The only subject on the agenda was "physiological pathology", but several points that had not been resolved on the 9th July were brought up again. On this occasion, Pierre Marie opened the debate and adopted a very cautious approach. However, his patience eventually ran out and he replied sharply to the comments of Dejerine on "images of language" and those of Dupré on "mental representations". Metaphorically speaking, it might be said that the gold medal was not awarded, Augusta Dejerine Klumpke took the silver, Dupré and André-Thomas shared the bronze, and Souques and Moutier each deserved a special mention. It might also be suggested that in 1908 the Society sketched out to a large extent the programme for research on aphasia for the century to come. (ABSTRACT TRUNCATE

Aphasia↗

The Thai version of Aachen aphasia test (THAI-AAT).

The lack of a standardized Thai Language aphasia test raises difficulties not only with the assessment and treatment planning for the clinical but also with the accurate diagnosis and the reliable incidence for research on aphasiology in Thailand. This study aimed to use the Thai version of German Aachen aphasia (THAI-AAT), which is systematically adapted according to well-defined linguistic criteria and psychometric requirement, to assess the language deficit of Thai aphasic patients. The subjects participating in this study were 125 aphasia patients, 60 non-aphasic brain damaged patients and 120 normal subjects. The result revealed that the THAI-AAT is linguistically parallel in test design and fulfills the same psychometric properties as the original. The THAI-AAT obtains the goals: to differential diagnosis of aphasia distinguishing it from non-aphasic disturbance and to identify the type of aphasic syndrome.

Aphasia↗

[A case of crossed aphasia with echolalia after the resection of tumor in the right medial frontal lobe].

We report a right-handed woman, who developed a non-fluent aphasia after resection of astrocytoma (grade III) in the right medial frontal lobe. On admission to the rehabilitation department, neurological examination revealed mild left hemiparesis, hyperreflexia on the left side and grasp reflex on the left hand. Neuropsychologically she showed general inattention, non-fluent aphasia, acalculia, constructional disability, and mild buccofacial apraxia. No other apraxia, unilateral spatial neglect or extinction phenomena were observed. An MRI demonstrated resected areas in the right superior frontal gyrus, subcortical region in the right middle frontal gyrus, anterior part of the cingulate gyrus, a part of supplementary motor area. Surrounding area in the right frontal lobe showed diffuse signal change. She demonstrated non-fluent aprosodic speech with word finding difficulty. No phonemic paraphasia, or anarthria was observed. Auditory comprehension was fair with some difficulty in comprehending complex commands. Naming was good, but verbal fluency tests for a category or phonemic cuing was severely impaired. She could repeat words but not sentences. Reading comprehension was disturbed by semantic paralexia and writing words was poor for both Kana (syllabogram) and Kanji(logogram) characters. A significant feature of her speech was mitigated echolalia. In both free conversation and examination setting, she often repeated phrases spoken to her which she used to start her speech. In addition, she repeated words spoken to others which were totally irrelevant to her conversation. She was aware of her echoing, which always embarrassed her. She described her echolalic tendency as a great nuisance. However, once echoing being forbidden, she could not initiate her speech and made incorrect responses after long delay. Thus, her compulsive echolalia helped to start her speech. Only four patients with crossed aphasia demonstrated echolalia in the literature. They showed severe aphasia with markedly decreased speech and severe comprehension deficit. A patient with a similar lesion in the right medial frontal lobe had aspontaneity in general and language function per se could not be examined properly. Echolalia related to the medial frontal lesion in the language dominant hemisphere was described as a compulsive speech response, because some other 'echoing' phenomena or compulsive behavior were also observed in these patients. On the other hand, some patients with a large lesion in the right hemisphere tended to respond to stimuli directed to other patients, so called 'response-to-next-patient-stimulation'. This behavior was explained by disinhibited shift of attention or perseveration of the set. Both compulsive speech responses and 'response-to-next-patient-stimulation' like phenomena may have contributed to the echolalia phenomena of the present case.

Adult↗

[A case of crossed aphasia in a dextral patient with polycythemia].

We report a 72-year-old right-handed man who was diagnosed as having crossed aphasia. He had polycythemia, hypertension and an old cerebral infarction in the right occipital lobe. He was admitted to our hospital because of muscle weakness in the left extremities at the age of 71. In the laboratory data, red blood cells(689 x 10(4)/microliter) and platelets(87.6 x 10(4)/microliter) were increased in number. Brain CT detected a right putaminal hematoma and an old infarct in the occipital lobe on the right. After admission, he developed non-fluent speech, and impairments of auditory comprehension, writing and naming due to the infarction in his right cerebral hemisphere including the middle cerebral artery distribution. The standard language test of aphasia(SLTA) revealed marked impairments in the language function, except for reading kana and kanji words. This writing was severely impaired compared with other language dysfunctions. Auditory comprehension, repetition and reading were impaired at the sentence level rather than at the kana word level. Furthermore, he suffered from left hemiparesis and left unilateral spatial neglect. We diagnosed his impairments of language function as crossed aphasia based on his right-handedness, CT findings and the results of SLTA. His language center was considered to be located in both cerebral hemispheres. Compared with typical findings in reported cases of crossed aphasia, the presence of both non-fluent speech and mutism were consistent with previous observations. However, the marked impairments of auditory comprehension, repetition and naming were different. Polycythemia and hypertension were considered to be the risk factors of cerebral infarction in our patient.

Aged↗

[Progressive aphasia. New data on an old phenomenon].

Progressive aphasias are distinct but infrequently recognized clinical expressions of non-Alzheimer lobar atrophy. We review and illustrate two such syndromes--semantic dementia (SD) and progressive nonfluent aphasia (PA). SD involves loss of conceptual structure due to bilateral infratemporal atrophy. PA is a phonetic-syntactic disorder resulting from left perisylvian atrophy. Early research on Pick disease--originally defined as circumscribed cerebrocortical atrophy--highlighted left temporal lobe atrophy and aphasia. For this reason (among others), Pick disease or Pick complex is still a useful and convenient label for progressive aphasias and other clinical manifestations of non-AD lobar atrophy.

Aged↗

[Aphasias for verbal and sign languages are due to lesions of nearly localised but not identical brain regions of the left hemisphere].

OBJECTIVES: To study the characteristics of verbal and sign language aphasia in a patient fluent in both languages, who had had a recent left hemisphere stroke as well as to localise the site responsible for Spanish sign language aphasia. PATIENT AND METHODS: 56 years old male, with risk factors for stroke, who presented an episode of sudden onset aphasia and right hemiplegia that partially recovered in a few hours. The residual deficit of language was explored with a detailed protocol that included comprehension, denomination, oral and phonetic praxis, propositional and automatic spontaneous language, reading and writing tasks. The examination of verbal and sign language was video-recorded. The lesion was localised by magnetic resonance imaging 24 days after the stroke. RESULTS: The patient, whose infarction involved the superior temporal gyrus and sylvian operculum, presented similar abnormalities for comprehension of complex sentences, many phonemic paraphasias and no trouble to repeat single words. Oral language was not fluent, but sign language was quite fluent with a rich vocabulary, but with semantic paraphasias, agrammatism and without self-criticism for his own mistakes. CONCLUSIONS: The pattern of oral and sign language alterations is partially different, more for expressive than perceptive discourse, although both types of aphasias are caused by lesions of the left hemisphere. The regions responsible for these abnormalities of both symbolic languages are localised close to each other, but not in the same place.

Aphasia, Broca↗

[Attention impairments in aphasia. Psychological aspects].

This paper reviews the relationship between the attention impairment and language functions in aphasia. It contains the description of some experiments with methods useful to examine the functions of attention: divided, selective, focused attention, suitable for patients with aphasia. The paper summarises the growing literature which documents the influence of divided attention on language functions such as: word retrieval, comprehension, spoken language, picture description. Lastly, the clinical implications of adopting the attentional model of aphasia are considered with respect to strategies for both assessment and treatment of adults with aphasia.

Aphasia↗

[A case of aphasia with preserved repetition due to anterior choroidal artery territory infarction].

A 55-year-old right-handed male patient with atrial fibrillation was admitted to our hospital because of a sudden disturbance of consciousness and right hemiparesis. Neurological examinations revealed left conjugate deviation of the eyes, aphasia, right hemianopsia without macula sparing using a Goldmann perimeter, right hemianesthesia, and right hemiparesis. Magnetic resonance imaging showed low intensity areas (left posterior limb of internal capsule, left cerebral peduncle of middle brain, a part of left substantia nigra, left amygdala, ventral posterior lateral nucleus and ventral anterior nucleus of left thalamus, left lateral geniculate body, and left occipital lobe) in T1 weighted image, due to the infarct in the left anterior choroidal artery territory. Aphasia in this case was accompanied with non-fluent speech, good repetition, naming deficits, and perseveration. We suggest that aphasia with anterior choroidal artery syndrome cannot be classified using the conventional system, and emphasize the importance of accurate descriptions of the symptoms characteristic of aphasia with anterior choroidal artery.

Aphasia↗

The TCM-combined treatment for aphasia due to cerebrovascular disorders.

OBJECTIVE: To evaluate the therapeutic effects of scalp acupuncture (with the cluster needling, a long needle-retention and an intermittent manipulation) combined with the Schuell's stimulation and psychological care for treatment of aphasia due to cerebrovascular disorders. METHOD: 36 eligible cases of aphasia were randomly assigned into a treatment group and a control group. The scoring system for assessment of aphasia in speaking Chinese set by CMA Neurological Branch and that of BADE were adopted for grading the severity/degree of aphasia before and after the treatment. RESULTS: The total effective rate in the treatment group was 84.21%, and that in the control group was 70.59%, with a very statistically significant difference (P < 0.01). CONCLUSION: The combined scheme produced a better therapeutic effect.

Acupuncture Therapy↗

[Acute aphasia].

Acute aphasia is in most cases due to cerebrovascular disease. Its occurrence is a strong indication of a lesion in the language-dominant hemisphere, i.e. usually the left. Aphasia has to be differentiated from confusional states, mutism and dysarthria. We present the different aphasic syndromes, the clinical evaluation of patients with aphasia, the differential diagnosis and etiological considerations. Finally, therapeutic approaches to aphasia treatment are pointed out.

Acute Disease↗

[Present situation and thinking of studies on apoplectic aphasia].

There were different emphasis between Chinese medicine and Western medicine in the study of apoplectic aphasia, the study of Chinese medicine lay particular emphasis on treatment with more interfering methods but lacking unifying evaluation criteria; while studies of Western medicine lay particular emphasis on studies of mechanisms, classification and language rehabilitation of aphasia, etc.. Selection and application of scientific study methods are key to attain expectation results of studies, and deeply make studies of apoplectic aphasia, so as to explore and establish the model of integrated Chinese and western medicine study of aphasia, promote rehabilitation of language function and increase life quality of the patient of apoplexy.

Aphasia↗

Syndromes in developmental dysphasia and adult aphasia.

We have attempted to draw some parallels between syndromes of adult acquired aphasia and of childhood developmental dysphasia. There appear to be two syndromes that are almost exact duplicates in the adults and the children: (a) pure word deafness and verbal auditory agnosia, and (b) aphemia and verbal dyspraxia. Two other syndromes seem to have rather close but not exact counterparts: Broca's aphasia and the phonologic-syntactic deficit syndrome, and transcortical sensory aphasia and the semantic-pragmatic deficit syndrome. There are two dysphasic syndromes, the phonologic production deficit syndrome and the lexical-syntactic deficit syndrome, that do not seem to have close adult counterparts. Neither of these dysphasic syndromes has been defined in adequate linguistic detail, and it is possible that their description may have to be modified when more data become available. Whether these comparisons between dysphasias and aphasias have heuristic value for guiding external validation studies of the clinically defined dysphasic syndromes of preschool children remains to be determined. Our purpose was to formulate hypotheses as to which cerebral systems are likely to be dysfunctional in children with clinically defined dysphasic syndromes. We recognize that the disorders of language acquisition and those of overlearned adult language have fundamental differences, and that plasticity of the child's developing brain introduces further complexities. Nevertheless, it seems reasonable to think that there are constants in brain organization that span all ages. Looking for language deficits common to aphasic adults (whose lesions can usually be delineated with contemporary neuroimaging techniques) and to dysphasic children (in whom there are rarely any neurologic clues) may be a fruitful way to begin to define the cerebral correlates of the children's deficits.

Adult↗

[Aphasia of deep localization].

A neurolinguistic and cerebral computed tomography (CT) study was carried out in 60 patients with aphasia. Fourteen had predominant subcortical involvement. Six of these showed involvement of the basal ganglia (5 with thalamic involvement), with small mass effect and small volume (less than 5 ml). The type of aphasia in this group was not uniform; it was remarkable, however, that initially there was mutism or initially non fluid language which soon became fluid in one half of the patients. Repetition and partially or totally preserved comprehension, together with dysarthic, dysprosodic and hypophonic abnormalities, were very common. The latter even had a more prolonged course than aphasic abnormalities. All the lesions in the remaining 8 patients had greater volume and were paracapsular in topography; 5 patients behaved as global aphasia (with a mean calculated volume of 23.7 ml), and the remaining 3 showed fluid aphasia, with an intermediate size (15 ml).

Adult↗

[Aphasia and size of hematoma in patients with left putaminal hemorrhage].

Presence or absence of aphasic syndrome and its duration were related to the volume of hematoma calculated from CT in 27 consecutive non-surgical cases with left putaminal hemorrhage. In the present study, patients classified into three groups regardless of the types of aphasia; i.e. non-aphasics, transient aphasics and persistent aphasics. Transient aphasics were arbitrarily defined as cases who had presented with more or less evident aphasic syndrome in the acute stage, but almost completely recovered in the chronic stage. Volume of hematoma in non-aphasic patients ranged from 2 to 17 ml, with a mean of 7.7 ml and those in transient cases were from 11 to 23ml with a mean of 17ml. All but one case with persistent aphasia showed the hematoma volume larger than 25ml. This exceptional case was a 83 year-old female who showed marked cortical atrophy on CT. Consequently, the presence of aphasia and its persistence seem to be largely dependent on the size of hematoma in patients with left putaminal hemorrhage. Persistent aphasia may be caused by organic damage of subcortical white matter, when the volume of hematoma exceeds around 25ml.

Adult↗