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PubMed1986

The labeling problem in aphasia: an illustrative case.

Twenty-five "experts" on neurogenic motor speech disorders participated in a tutorial exercise. Each was given information on M, a patient who had communication difficulties as the result of stroke, and asked to complete a questionnaire about his problem. The information included a detailed case description, an audiotape of M's speech obtained at 4, 9, 13, and 17 days post-stroke, and test results from the Western Aphasia Battery, the Token Test, and a battery for apraxia of speech. The experts were in excellent agreement on M's primary problem, although it was called by seven different names. The experts were in poor agreement on his secondary problem(s), e.g., the presence and type of aphasia and dysarthria. The results suggest that labeling is difficult, even for "experts." Furthermore, the practicing clinician needs to be sensitive to the likelihood of more than one coexisting problem.

Adult↗
PubMed1988

Grammaticality judgments and sentence comprehension in agrammatic aphasia.

The relationship between sentence comprehension and grammaticality judgment was examined for both neurologically intact and agrammatic aphasic subjects. Aphasic subjects were able to make grammaticality judgments and comprehension judgments, but were less accurate than healthy control subjects. However, the tasks appeared dissociated for the aphasic subjects: Both the effects of semantic cues and the hierarchy of difficulty of sentence types differed across the two tasks. Further, the findings suggest that not all aspects of morpho-syntactic processing may be equally disrupted in aphasia. The results argue against both a central deficit view of agrammatic aphasia, and a view suggesting that syntactic processing is intact whereas semantic or thematic mapping is not. Instead, the results indicate that the respective performance domains of comprehension and grammaticality judgment may draw on different processes and/or operate on different aspects of the language input.

Adult↗
PubMed2002

Postictal mixed transcortical aphasia.

Postictal aphasia has been described in left temporal lobe seizures. It may be of fluent, non-fluent or global type. We present here a patient who displayed signs of mixed transcortical aphasia (MTCA). The patient was a 67 year old man who underwent excision of a left frontal parasagittal meningioma in 1987. Since then he has been treated with phenytoin for generalized tonic-clonic seizures (GTCS). He was admitted in status epilepticus. On awakening, the patient was non-fluent with palilalia and echolalia. His repetition was relatively preserved but all the other language functions were impaired. This picture faded away within a few hours. Brain CT, performed during this postictal state, was normal except for signs related to frontal craniotomy. SPECT, which was performed after language functions returned to normal, displayed left frontal, cingular and insular hypoperfusion. The postictal language dysfunction of the patient corresponded to MTCA. Although our case has frontal, he had no other structural lesion that could explain either diffuse ischemia of the left hemisphere or watershed areas secondary to the generalized seizures. The uniqueness of this case is the combination of postictal MTCA with good prognosis.

Aged↗
PubMed1994

[Mutism and aphasia--a review of the literature].

Mutism in the sense of a complete inability to produce oral language is a rare symptom in aphasic disorders and most often occurs as a transient initial sign. Among the pathomechanisms causing muteness in aphasia, disturbances of speech initiation and of limbic aspects of speech production on the one hand and speech motor programming impairments on the other are considered. This article reviews clinical reports of extremely reduced speech or complete muteness in the context of aphasia, discussing the observed symptom patterns as well as their neuroanatomic correlates and aspects of their recovery.

Aphasia↗
PubMedDate not supplied

'I suppose' as a resource for the construction of turns at talk in agrammatic aphasia.

This paper uses the methodology and analytical findings of conversation analysis to investigate the use of a particular subject-verb construction within the context of turns at talk in conversation. An investigation of the conversation of an English speaking man with agrammatism reveals recurrent use of 'I suppose' to provide structure within turns at talk. The speaker's ability to produce subject-verb constructions is known to be generally poor. Thus, it is suggested that the use of a particular construction that can be produced with relative ease may be interactionally motivated by the need to take a reasonably unproblematic turn at talk despite the constraints of an agrammatic aphasia. Preliminary thoughts on the implications of this finding for the assessment of aphasia are presented.

Adaptation, Psychological↗
PubMed1982

Aphasia in a prelingually deaf woman.

A left parietal infarct in a prelingually deaf person resulted in an aphasia for both American Sign Language (ASL) and written and finger-spelled English. Originally the patient had a nearly global aphasia affecting all language systems. By five to seven weeks post-onset her symptoms resembled those of hearing aphasics with posterior lesions: fluent but paraphasic signing, anomia, impaired comprehension and repetition, alexia, and agraphia with elements of neologistic jargon. In addition, there was a pronounced sequential movement copying disorder, reduced short-term verbal memory and acalculia. In general, the patient's sign errors showed a consistent disruption in the structure of ASL signs which parallels the speech errors of oral aphasic patients. We conclude that most aphasic symptoms are not modality-dependent, but rather reflect a disruption of linguistic processes common to all human languages. This case confirms the importance of the left hemisphere in the processing of sign language. Furthermore, the results indicate that the left supramarginal and angular gyri are necessary substrates for the comprehension of visual/gestural languages.

Aged↗
PubMed1984

A two-route model of speech production. Evidence from aphasia.

Quantitative investigations of speech production deficits are reported in three aphasic patients. Two had impaired paraphasic performance in repetition tasks but relatively well preserved spontaneous speech (conduction aphasia). The other patient had impaired paraphasic spontaneous speech but intact repetition (transcortical motor aphasia). In repetition tasks which required active semantic processing the conduction aphasics were facilitated and the transcortical motor aphasic impaired; in tasks which required passive repetition the opposite pattern of dissociation was observed. These findings are accounted for within a two-route model of the speech production process.

Aphasia↗
PubMed1989

Severe nonfluency in aphasia. Role of the medial subcallosal fasciculus and other white matter pathways in recovery of spontaneous speech.

The relationship between location and extent of lesion on CT scan and limitation in spontaneous speech was examined. The severity of spontaneous speech ranged from cases with no speech or only verbal stereotypies (first major group) to those with reduced, hesitant, poorly articulated, agrammatic speech (nonfluent Broca's aphasia, second major group). CT scan analysis revealed no single neuroanatomical area that contained an extensive lesion which could be used to discriminate the most severe cases from the least severe. The two groups were separable, however, on the basis of the CT scan when the extent of the lesion in two subcortical white matter areas were combined: (1) the most medial and rostral portion of the subcallosal fasciculus plus (2) the periventricular white matter near the body of the lateral ventricle, deep to the lower motor/sensory cortex area for the mouth. The most rostral portion of the medial subcallosal fasciculus, located in the lateral angle of the frontal horn (extremely deep to Broca's area), contains projections from the cingulate gyrus (area 24) and the supplementary motor area, to the caudate nucleus. We suggest that one explanation for the more severe limitation in spontaneous speech in the first group is the extensive white matter lesion in these two subcortical pathways had interrupted a large number of connections for (1) initiation and preparation of speech movements, and limbic aspects of speech (lesions in the medial subcallosal fasciculus), and (2) motor execution and sensory feedback for spontaneous speech (lesions in periventricular white matter deep to the motor/sensory cortex area for the mouth). Extensive lesion in only one of these two white matter pathway areas, alone was not sufficient to produce long-lasting severe limitation in spontaneous speech and could not be used to discriminate the two groups on the basis of the CT scans. The patients with less severe limitation in spontaneous speech (nonfluent Broca's aphasia) had less extensive lesion within these two white matter areas combined, and had interrupted a smaller number of these subcortical connections. The sites of the lesions in subcortical white matter in CT scans in Broca's original case who could only produce a verbal stereotypy are similar to those in our first group with the most severe limitation in spontaneous speech. The presence or absence of hemiplegia was not related to severity or recovery of spontaneous speech. Careful examination of lesion extent in these two areas of subcortical white matter on CT scanning appears to be relevant in predicting potential for recovery of spontaneous speech in some stroke patients.

Adult↗
PubMed1985

Aphasia, apraxia and neurogenic stuttering as complications of metrizamide myelography (speech deficits following myelography).

Aphasia following metrizamide myelography has been reported infrequently. During a seven-month period, we examined two patients who developed Broca's aphasia, apraxia of speech, oral-buccal-facial apraxia and neurogenic stuttering after intrathecal metrizamide administration. In each case, focal neurologic deficits were accompanied by clinical, electroencephalographic and radiologic signs of generalized neurologic disease. Serial speech and language evaluations initially revealed severe deficits that were largely resolved by the third day post-myelography. Out-patient follow-up examinations demonstrated persistence of mild speech and language abnormalities in each case. Our findings suggest that metrizamide may cause longlasting neurologic dysfunction.

Aphasia↗
PubMed1981

Word deafness in Wernicke's aphasia.

Three patients with otherwise typical Wernicke's aphasia showed consistent superiority of visual over auditory comprehension. The precedents for and anatomical basis of a selective auditory deficit in Wernicke's aphasia are discussed, including the relationship to pure word deafness. One implication of spared visual language function may be the use of gesture in language therapy for such patients.

Aphasia↗
PubMed1982

Alexia and agraphia in Wernicke's aphasia.

Three patients with otherwise typical Wernicke's aphasia showed consistently greater impairment of reading than auditory comprehension. While this syndrome resembles alexia with agraphia, the paraphasia of speech, repetition, and naming underline the aphasic nature of the disorder. Together with previous reports of isolated word deafness in Wernicke's aphasia, these cases suggest a relative independence of auditory and visual language processing.

Aged↗
PubMed1990

A case of progressive aphasia without dementia: "temporal" Pick's disease?

We report a patient who suffered from progressive aphasia for nine years, before developing mild behavioural disturbances. Sequential computed tomography (CT) scanning and magnetic resonance (MRI) imaging showed progressive bilateral temporal atrophy. The case is thought to be a temporal form of Pick's disease, in which isolated progressive aphasia was the only symptom over many years.

Aphasia↗
PubMed2004

Functional MRI follow-up study of language processes in healthy subjects and during recovery in a case of aphasia.

BACKGROUND AND PURPOSE: The goal of this study was to develop a functional MRI (fMRI) paradigm robust and reproducible enough in healthy subjects to be adapted for a follow-up study aiming at evaluating the anatomical substratum of recovery in poststroke aphasia. METHODS: Ten right-handed subjects were studied longitudinally using fMRI (7 of them being scanned twice) and compared with a patient with conduction aphasia during the first year of stroke recovery. RESULTS: Controls exhibited reproducible activation patterns between subjects and between sessions during language tasks. In contrast, the patient exhibited dynamic changes in brain activation pattern, particularly in the phonological task, during the 2 fMRI sessions. At 1 month after stroke, language homotopic right areas were recruited, whereas large perilesional left involvement occurred later (12 months). CONCLUSIONS: We first demonstrate intersubject robustness and intrasubject reproducibility of our paradigm in 10 healthy subjects and thus its validity in a patient follow-up study over a stroke recovery time course. Indeed, results suggest a spatiotemporal poststroke brain reorganization involving both hemispheres during the recovery course, with an early implication of a new contralateral functional neural network and a later implication of an ipsilateral one.

Acoustic Stimulation↗
PubMed1980

Crossed aphasia in a dextral: a clinicopathological study.

Severe Broca aphasia and left hemiplegia without right limb apraxia occurred suddenly in a right-handed man with no personal or family history of left-handedness. Postmortem examination showed infarction of the right hemisphere, limited almost entirely to the precentral gyrus. In this patient, cerebral dominance for speech lay in the right hemisphere, but dominance for limb praxis lay in the left. This case provides evidence that cerebral dominance for speech and handedness in dextrals may be dissociated. It also suggests that lesions of the precentral gyrus are of major importance in producing Broca aphasia.

Aged↗
PubMed1984

Crossed Wernicke's aphasia.

Severe Wernicke's aphasia occurred suddenly in a right-handed man and persisted with little improvement until he died 54 days later. Postmortem examination showed an infarct in the posterior temporoparietal region of the right hemisphere. This case demonstrates two new features of crossed dextral aphasia. First, language skills may be fully lateralized to the right hemisphere in right-handed patients. Second, when crossed lateralization occurs, the usual localization of aphasic syndromes is common, suggesting that the intrahemispheric organization mediating language activities is the same in the right hemisphere of the crossed dextral and the left hemisphere of the typical right-handed individual.

Aged↗
PubMed1984

Reading: selective sparing of closed-class words in Wernicke's aphasia.

One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability to read closed-class words (eg, articles, prepositions) with a preserved ability to read open-class words (eg, nouns, verbs). We examined a man with profound Wernicke's aphasia induced by an infarct of the posterior portion of the superior temporal gyrus (Wernicke's area). He could not read substantive words or pronounceable nonwords but could read closed-class words. These observations suggest that the reading of closed- and open-class words is mediated by separable systems. Whereas the anterior perisylvian region appears to be important in reading functional words, the posterior perisylvian region is important in reading substantive words.

Aged↗
PubMed1987

Transcortical sensory aphasia in China.

Three cases of transcortical sensory aphasia in Chinese speakers were associated with left parieto-temporal junction strokes. The possibility that this relatively rare aphasia syndrome is more common in the Chinese is raised and a theoretical explanation based on differences in Oriental written language is presented.

Aphasia↗