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PubMed2001

The many faces of crossed aphasia in dextrals: report of nine cases and review of the literature.

A substantial body of the aphasia literature has been devoted to the topic of crossed aphasia in dextrals (CAD) over the past century but still no theory exists that explains the anomalous organization of neurocognitive functions in this population. However, if strict selection criteria are applied only some cases of vascular CAD are reported in which the correlation between neurocognitive disturbances and the locus of the brain lesion is studied. This study describes nine new cases of vascular CAD who underwent in-depth neurolinguistic and neuropsychological investigations. Our analysis shows the semiological variability of CAD phenomena and the many faces of the lesion-behaviour relationships of this exceptional neurobiological condition.

Adult↗
PubMed2001

Jargonagraphia with severe aphasia due to a right hemisphere lesion: case report.

The authors report a case of a patient who developed jargonagraphia, severe aphasia, unilateral spatial neglect and apraxia due to a right hemisphere lesion. Jargonagraphia with severe aphasia, unilateral spatial neglect and apraxia is quite rare. The mechanisms of jargonagraphia remain unknown. A possible mechanism underlying this case of jargonagraphia is discussed.

Agraphia↗
PubMed1978

[Acquired aphasia with electroencephalographic manifestation in children (author's transl)].

The paper presents the case of a 5 year old boy with the syndrome of gradually developing aphasia, primarily receptive, associated with electroencephalographic abnormalities and behavioral problems. The aphasia developed over a period of 1 1/2 years and was primarily concerned with receptive language. At its peak there was a complete loss of language which coincided with almost continuous spike-wave discharges in EEG as did behavioral problems (hyperactivity and aggressiveness). No seizures occured. With anticonvulsive medication the abnormal EEG-activity diappeared within a 3 week period. Language improvement only began slowly 2 months later. Complete restitution of language was attained 1 year after the total loss of language. As the language improved, the behavior normalized. Various specialist were engaged in the diagnosis of the case and their procedures are described. The cause of this syndrome remains unknown. Similar cases (often with convulsive disorder) reported in literature are discussed and presented in a table.

Aggression↗
PubMed2001

[Aphasia and dementia].

Primary progressive aphasia (PPA) is an uncommon neurodegenerative syndrome characterized by a relatively isolated dissolution of language function at the beginning, followed by deterioration of general cognitive function and of activities of daily living after 2 or more years. On account of neuropathological and clinical findings, PPA is supposed to form part of the spectrum of frontotemporal lobar degeneration. We present a case study of a 66-year-old woman with a probable fluent progressive aphasia. She initially experienced word amnesia and developed after 2 - 3 years gradual regression of word comprehension, over-fluent speech with semantic paraphasias, and at last generalized dementia. In addition to minor bilateral cortical volume reduction on CCT, MRI showed left temporal lobe atrophy involving hippocampus, SPECT revealed reduced uptake left frontal and temporal.

Aged↗
PubMed1986

[Aphasia in children].

The acquired aphasia in children is a rarely seen speech and language disorders. Disturbances develop after the child has already achieved the capacity for language comprehension and verbal expression. Brain trauma is most often the cause. The clinical picture of the disorder varies over different age groups and, in contrast to adults, shows no consistent typology. In most of the cases there exists a disturbance of speech production; problems with writing and comprehension are seen less often (although comprehension of language is primarily affected in the Landau-Kleffner syndrome). Only once and a while logorrhoea and jargon can be diagnosed. Besides the speech and language disorders cognitive, motor und emotional problems may appear. Therefore, several diagnostic levels have to be considered (e.g. clinical neurology, neuropsychology, psychophysiology, psychopathology). Course and prognosis of the acquired aphasia in childhood (30% longterm difficulties) depend on several factors like etiology and extension of the lesion, the development of the functional hemispheric dominance for language and the initial recovery velocity after the symptoms appeared. The plasticity of the child's brain is a source for compensating mechanisms which might be triggered by three aspects of therapeutic activities which should be used synchronously: speech and language training, principles of psychotherapy and social medicine and treatment of additional disorders.

Adolescent↗
PubMed1999

Assessment of mood states in aphasia.

Depression is common in patients with stroke and other neurological conditions. Accurate assessment and diagnosis is critical in understanding the causes of mood disturbance in these patients and in establishing effective treatments. Examination of mood states, however, is difficult in patients with aphasia, impaired emotional expression, and other communication and cognitive difficulties. Most standardized measures of mood are inappropriate for this population due to the instruments' linguistic, attention, and other cognitive demands. The Visual Analog Mood Scales (VAMS) are psychometrically sound measures, developed specifically for neurologically impaired patients in general and aphasic patients in particular. These very brief scales assess eight mood states: sad, happy, tense, afraid, tired, energetic, confused, and angry. The utility of these scales in clinical practice is presented, as are specific recommendations and guidelines for the assessment of mood in patients with aphasia and other communication deficits.

Aphasia↗
PubMed2003

Dissociation between personal and extrapersonal neglect in a crossed aphasia study.

Abstract Several reports document crossed aphasia following a right cerebral infarct. However, few of them provide a detailed investigation of associated neuropsychological disorders. A personal neglect disorder with no difficulty in orienting attention in the contralesional space has not been frequently reported independently of lesion side for the language deficit. In most cases, the deficit is described in the acute period. We report the case of a patient who showed severe crossed aphasia several months after cerebral damage. In addition to his language deficit, he suffered from finger agnosia, acalculia, and right/left confusion. Although he was able to orient attention in the contralesional space, he had a persistent personal neglect disorder with severe difficulty in attending to his own body. Results suggest that right hemisphere language dominance does not preclude ipsilateral specialisation for other functions. Furthermore, the dissociation between the two spatial functions provides further confirmation that they are subserved by two independent systems.

Agnosia↗
PubMed1982

Neuropsychological analysis of a case of crossed aphasia: implications for reversed laterality.

We present a case of crossed aphasia and reversed laterality in a 60-year-old right-handed man. Neuropsychological assessment was conducted both prior, and three months subsequent, to the removal of a right temporal lobe tumor. Results, using the Luria-Nebraska Neuropsychological Battery, Wechsler Memory Scale and WAIS Block Design, plus various drawings from copy and to command revealed: (1) presurgery Luria profile very close to the mean profile for dominant temporal lobe dysfunction, (2) preserved visuospatial and visuoperceptive skills, (3) preserved limb praxis, and, (4) good postsurgery functional recovery. These findings are discussed in relation to literature on crossed aphasia and reversed laterality.

Aphasia↗
PubMed1985

Recovery from aphasia following extracranial-intracranial bypass surgery: case report.

The Boston Diagnostic Aphasia Exam and brief measures of memory, stereognosis, and limb praxis were administered to an extracranial-intracranial bypass surgery patient with moderately severe transcortical aphasia preoperatively and postoperatively. Significant improvement in language function was documented 2 days following surgery. Three month followup demonstrated continued improvement across all major areas of language function. These improvements were not felt to be attributable to practice effect, the natural remission of aphasic symptomatology or change in general medical status. Our experience with this patient leads us to speculate that patients with multivessel occlusive disease limiting cerebral oxygen supply to the vascular borderzone area may be more likely to benefit from bypass surgery and an increase in cerebral blood flow than some other subgroups of patients with cerebrovascular disorders.

Aged↗
PubMed1988

Dichotic-listening evidence of right-hemisphere involvement in recovery from aphasia following stroke.

A dichotic-listening procedure was used to investigate the role of the right hemisphere in recovery from aphasia following left-hemisphere stroke. Thirty-one stroke patients were divided into three groups: (a) patients who were recovering from aphasia (Aphasic group, n = 11), (b) patients who had experienced mild strokes with only transient dysarthria (Dysarthric group, n = 10), and (c) patients who had sustained right-hemisphere stroke with no language disturbance (Nonaphasic group, n = 10). In addition, a group of normal, healthy volunteers served as a control group (n = 11). Results show that, like the Control subjects, the Dysarthrics and Nonaphasics showed a strong right-ear advantage (REA) for dichotically presented consonant-vowel (CV) syllables. This is usually thought to be an indication of left-hemisphere dominance (Kimura, 1961). By contrast, the Aphasic group showed left-ear advantage (LEA) suggesting a shift in cerebral dominance for language. The possibility that the results were due to sensory degradation of the auditory messages (lesion effect) was explored. This idea was rejected in favor of an explanation based on increased right-hemisphere mediation of language following left-hemisphere aphasiogenic lesions.

Adult↗
PubMed2001

Transient crossed aphasia and persistent amnesia after right thalamic haemorrhage.

A 45-year-old right-handed woman suffered transient aphasia and persistent amnesia after a right thalamic haemorrhage. This patient appeared to have crossed aphasia, although it disappeared within 8 weeks. It is noteworthy that the patient had a unilateral right thalamic lesion but exhibited both verbal and non-verbal memory impairment. Computed tomography and magnetic resonance imaging revealed cerebral haemorrhage in the right thalamus involving the ventral anterior nucleus, medioventral nucleus, mamillothalamic tract, internal medullary lamina, and mediodorsal nucleus. An amytal test was performed and suggested that the right hemisphere was dominant for language functions and the left hemisphere was dominant for visuospatial functions. Single photon emission CT revealed a low perfusion area only in the right thalamus. These findings suggest that the right hemisphere might be dominant for both verbal and non-verbal memory function in this patient, although visuospatial function was lateralized in the left hemisphere.

Amnesia↗
PubMed1996

Brown-Séquard and cerebral localization as illustrated by his ideas on aphasia.

Brown-Séquard's concept of localization was built on the phenomena of inhibition and dynamogenesis, constituting a dynamic system in which reflex mechanisms, that played a part not only in the spinal cord but in the brain as well, were considered of particular importance. The use of this concept is considered in Brown-Séquard's discussion of the subject of cerebral localization, and especially of aphasia. The origin and development of Brown-Séquard's ideas on aphasia from 1861 onwards are discussed, as is the part he possibly played in the transfer of knowledge from Paris to London (Broca and Jackson). In the 1870's Brown-Séquard debated on cerebral localization with Charcot before the Société de Biologie. Opposing the cluster theory of localization, Brown-Séquard developed the theory of "réseau de cellules anastomosées", a kind of network theory in which scattered cells subserving the same function are connected by nerve fibers. This was to him a plausible theory, with which he was able to explain the fact that damage in several locations may produce the same effect, and, to account for observations that some functions remain unimpaired despite extensive brain-injury. Although Brown-Séquard's arguments were not always valid, because they were based on imprecise observations, his dynamic model, nowadays, seems valuable. He influenced "anti-localizers" such as Goltz, but also Jackson and probably Von Monakow and Sherrington.

Aphasia↗
PubMed2004

Primary progressive aphasia: a review.

This review summarizes clinical and imaging features associated with primary progressive aphasia (PPA). We investigate the hypothesis that these patients can be divided into subgroups of progressive non-fluent aphasia (PNFA) and semantic dementia (SD), based on their linguistic profiles and related imaging studies, and examine whether each of these major subgroups can be further subdivided. We focus on several critical features within each progressive aphasic subgroup. In PNFA, we examine agrammatism, phonologic disorder, and impaired verb processing to determine whether this syndrome is related to a modality-specific impairment in word formation and articulation, or a conceptual deficit that interferes with grammatical processing. In SD, we examine impaired semantic memory, limited remote memory, and anomia to assess whether this syndrome is due to a modality-neutral interruption of semantic memory, or the degradation of various material-specific representations of object features and words. We conclude that there is sufficiently consistent and converging evidence from clinical and imaging studies to support the claim that PNFA and SD are distinct subgroups of PPA. However, there does not appear to be sufficient evidence at this point to support further discrimination within these progressive aphasic subgroups. Testing hypotheses about finer-grained syndromes such as progressive dysarthria or progressive anomia has important consequences for improving our understanding of language organization and the neural basis for language.

Aphasia, Primary Progressive↗
PubMed2005

Pathophysiology of language switching and mixing in an early bilingual child with subcortical aphasia.

Acquired aphasia after circumscribed vascular subcortical lesions has not been reported in bilingual children. We report clinical and neuroimaging findings in an early bilingual boy who incurred equally severe transcortical sensory aphasia in his first language (L1) and second language (L2) after a posterior left thalamic hemorrhage. Following recurrent bleeding of the lesion the aphasic symptoms substantially aggravated. Spontaneous pathological language switching and mixing were found in both languages. Remission of these phenomena was reflected on brain perfusion SPECT revealing improved perfusion in the left frontal lobe and left caudate nucleus. The parallelism between the evolution of language symptoms and the SPECT findings may demonstrate that a subcortical left frontal lobe circuity is crucially involved in language switching and mixing.

Adolescent↗
PubMed2006

Suggestive evidence for an involvement of the right hemisphere in the recovery from childhood aphasia: a 3-year follow-up case study.

We describe the case of an 11-year-old, previously healthy, pre-puberal, right-handed girl with acquired aphasia following an extensive cerebral hemorrhage into a left hemisphere brain tumor. A 3-year follow-up evaluation of the girl's communicative performance showed an incomplete recovery of linguistic abilities with a good recovery of comprehensive components, but persisting severe impairment in expressive language. At the end of the follow-up period, with the aim of assessing the lateralization of some linguistic abilities, we carried out an experimental investigation using tachistoscopic reading and object naming tests along with a dichotic listening test. All these tests showed a clear left field/left ear-right hemisphere advantage. We discuss both clinical and experimental results with regard to implications for the linguistic abilities of the right hemisphere in late versus early childhood and its interaction with aetiology in the recovery from acquired childhood aphasia.

Aphasia↗
PubMed2006

A case study of Primary Progressive Aphasia: improvement on verbs after rTMS treatment.

This case-report shows that high frequency repetitive Transcranial Magnetic Stimulation (hf-rTMS), applied to the left prefrontal cortex, may improve the linguistic skills in Primary Progressive Aphasia (PPA). The patient's performance was evaluated on a battery of language production and memory span tasks, before and after two hf-rTMS treatments and one SHAM treatment. We observed a significant and lasting improvement of the patient's performance on verb production following the application of hf-rTMS versus Baseline and SHAM conditions. This finding suggests that hf-rTMS may directly strengthen the neural connections within an area of metabolic dysfunction and encourages the use of rTMS as an alternative therapeutic tool for neurodegenerative forms of aphasia.

Aphasia, Primary Progressive↗
PubMed2006

Language and visuospatial impairment in a case of crossed aphasia.

Crossed aphasia in dextrals (CAD) constitutes an interesting model for understanding the lateralisation and interaction of language with other cognitive functions in the brain. The authors present a study of a right-handed patient with Wernicke's aphasia following a right hemisphere cerebrovascular accident, who also had impairment in visuospatial skills. Although the patient presented a remarkable improvement in language symptoms on longitudinal follow-up, the combination of linguistic, visuospatial, and attentional impairments ultimately resulted in a persisting inability to perform complex tasks. The study of mild residual disturbances can improve our understanding of the interaction of language with other cognitive functions, going some way towards explaining the particular features found in CAD.

Adult↗
PubMedDate not supplied

A multinational comparison of aphasia management practices.

The effect of restructuring of healthcare on the quality, quantity, and nature of aphasia management is largely unknown. The current study is the first to examine access, diagnostic, treatment, and discharge patterns of patients with aphasia in Australia, Canada, the UK, the US private sector (US-Private), and the US Veterans Health Administration in the Department of Veterans Affairs (US-VA). The authors developed a 37-item survey to be completed by clinicians working with aphasic patients. The survey focused on eight areas: access to care, evaluation procedures, group treatment, number and duration of treatment sessions, limitations of the number of sessions, termination of treatment, follow-up practices, and resumption of treatment. 394 surveys were distributed and 175 were returned completed (44% return rate). Respondents represented a range of ages, work experiences, and work settings. There was considerable consistency among respondents from our five healthcare systems. Results suggest that patients may be routinely denied treatment in direct contradiction to the research literature. Just as we carefully monitor the progress of patients receiving our treatment, we are obliged to monitor the effects of managed care on our patients, fellow clinicians, and our profession.

Americas↗