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[Charcot and cerebral localizations. From aphasia to amnesia].

During the course of his convincing research into localizing cerebral motor areas, Charcot used the clinico-pathological method and his faith in localization for the study of aphasia. Thus, in 1883, he gave a course on the subject which is one of the most complex among the study of cerebral diseases. In this series of lessons, he was able to organize data from clinical studies, anatomy and psychology. In fact, for Charcot in 1883, aphasia was simple a particular kind of amnesia which could be taken as more or less severe partial loss of word memory. Memory itself would not exist, but would be divided into a number of autonomous partial memories. Charcot did not discover until some years later, basically from observing patients with hysteria, that memory is not only a stock of sensations but that it can also be used to save personal, autobiographical information. This led him to consider memory impairment not only as an organic disease but also as a psychological disease.

Amnesia↗
PubMed1994

[Transcortical sensory aphasia in a patient with metastatic brain tumor in the left frontal lobe].

We reported a case of a 62-year-old right-handed woman who had transcortical sensory aphasia caused by a metastatic brain tumor in the left frontal lobe. She had mild right hemiparesis involving the face, without hyperactive tendon reflexes. She had neither sensory disturbance nor other cranial nerve deficits. Her spontaneous speech was fluent, and she sometimes had echolalia. Her object naming, word fluency, verbal comprehension and writing were severely disturbed. This contrasted with full preservation of repetition of phonemes and short sentences. Reading of words was preserved. CT scan revealed a subcortical lesion in the left superior frontal gyrus. Gd-enhanced MRI showed a ring-enhanced mass lesion in the frontal lobe outside of Broca's area. We thereby concluded that transcortical sensory aphasia may be caused by frontal lobe lesion independent of the perisylvian speech areas.

Adenocarcinoma, Papillary↗
PubMed1994

[Transcortical sensory aphasia following a left frontal lesion--case report].

We report a patient with transcortical sensory aphasia (TCSA) following a left frontal lesion. The patient was a 63-year-old right handed Buddhist priest admitted to our hospital with a complaint of word-finding difficulty. Neurological examination failed to reveal any abnormal findings except aphasia. The patients spontaneous speech was fluent, not agrammatic, and free of phonemic paraphasia but he sometimes exhibited semantic paraphasia. His ability to repeat sentences was excellent, but he had severe difficulty in word-finding, auditory comprehension and writing. He read aloud correctly, but his reading comprehension of kana (phonograms) was poor in contrast to excellent reading comprehension of kanji (morphonograms). His clinical picture was characterized by poor comprehension but excellent repetition, and a diagnosis of TCSA was made. CT and MRI revealed an infarction involving the pars opercularis and pars triangularis in the inferior frontal gyrus and the anterior portion of the lower prefrontal gyrus and the middle frontal gyrus. Regional cerebral blood flow was measured by single photon emission CT and was found to be decreased in the same region as indicated on CT and MRI. The clinical picture in this patient was comparable to that of TCSA due to a posterior parieto-occipital lesion, but the rapid improvement (within 1 to 2 months) of this patient was characteristic. Auditory comprehension, kana (phonograms) reading comprehension, and word recall, which were severely impaired in this patient, all demand interaction between phonological processes and semantic processes. Thus we conclude that this patient had impairment of the phonological-semantic interaction process.

Aphasia, Wernicke↗
PubMed1994

[A 52-year-old man with sensory aphasia and multiple intracranial masses].

We report a 52-year-old-man who developed aphasia, apraxia and agnosia. He was well until December of 1991 when he noted an onset of skin scaling in the extensor sides of his elbow joints; he was admitted to the dermatology service of our hospital and was diagnosed as having pemphigoid. Treatment with PDN 30 to 60 mg/day and azathioprine 50-100 mg was started. While in the hospital there was a insidious onset of right tinnitus and tingling sensation in his right leg in the middle of March, 1991. During next one week, his family noted that the patient responded incoherently in his speech once in a while. Neurological consult was requested on April 2, 1991. On neurologic examination, he was alert but incoherent in his speech. His spontaneous speech was reduced but it was fluent. However, he had a difficulty in understanding spoken as well as written language. Naming and repetition were also impaired, and he appeared to have Wernicke's aphasia. Ideational apraxia, ideomotor apraxia, constructional apraxia, left-right disorientation, finger agnosia, and body agnosia were noted as well, but he did not have dressing apraxia or spatial disorientation. Right homonymous hemianopsia was present, but any other cranial nerves were not disturbed. He had no weakness or ataxia; gait was normal. Deep reflexes were normal and symmetric. Sensations were intact. Complete blood counts and routine blood chemistries were normal. The lung was clear. Opening pressure at spinal tap of CSF was under a normal pressure; CSF contained 6 lymphocytes/microliters and 78mg/dl of protein; a cytological study showed no malignant cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Aphasia, Wernicke↗
PubMed1977

[NEOLOGISMS AND MOTOR APHASIA. (Afferent pathology?)].

The authors describe a case of post-traumatic aphasia in a 39-year-old man. The linguistic disturbances were marked by the unusual association of oral expression consisting mainly of neologisms, normal comprehension and almost normal written expression. A physiological interpretation based on disturbance of treatment of the sensory afferent nerves from the bucco-phonator organs is suggested to account for the neologisms in this particular form of aphasia.

Adult↗
PubMed1977

[Total aphasia and speech therapy: a case history (author's transl)].

The medical profession and therapists continue to believe that total aphasia is untreable. A case report is used to demonstrate the diagnostic features of aphasia and describe the course of the impairment from the complete loss of speech, via the learning of highly automated expressions to the aquisition of single words which the patient uses independently in the different contexts. This development involves all language functions equally. The therapy is based on conventional methods, deblocking stategies, speech therapeutic talks - principal item of the treatment - and dialogue exercises carried out under normal conditions. The problems relating to deblocking methods are discussed. A description is made of the methods which have been developed from a combined audiovisual, tactile and writing motoric speech activation programme. The article presents the linguistic signs of the syndrome in an advanced stage and demonstrates the development of the thinking structure and the psychic problems with the help of the tree drawings.

Aphasia↗
PubMed1996

Aphasia, dichotic testing and defective hearing.

Cerebral lesions causing aphasia are often found close to auditory areas. The aphasia may therefore sometimes be aggravated by hearing problems, which are concealed by communicative restrictions. Unilateral lesions of the cerebral auditory system influence the functional ear preference disclosed by dichotic tests. For that reason we have examined aphasic patients with recent, initial, unilateral brain infarctions for ear preference with regard to dichotically presented two syllable words. In a consecutive series of 114 patients who could cope with the test, 29 showed signs of an acquired left ear advantage (LEA). All were offered, and 22 accepted a full scale audiological examination including pure tone, speech and phase-audiometry. Nine of these patients showed retrocochlear or central hearing disturbances, which added to their communicative predicaments. The LEA of 11 patients lacked audiological rationales and a compensatory shift of cerebral speech-lateralization cannot be excluded.

Adolescent↗
PubMed1977

[Applied phoniatry. VI. The dysarthria and aphasia syndromes as a result of cranial nerve palsies (author's transl)].

Dysarthria and aphasia represent primary symptoms of cerebral nerve dysfunction, and may particularly involve the facial and the hypoglossal nerves. In order for management to be effective, careful examination of the muscular functions of the oral cavity is required, with particular emphasis placed on the movements of the tongue and velum. Such evaluation, which utilizes both neuropsychologic and linguistic determinations, permit an accurate differentiation of the possible causes of aphasia to be made. During the evaluation, both verbal and non-verbal responses by the patient are included for proper diagnosis and therapy. Of great value in obtaining an accurate differential diagnosis is the exclusion of disturbances of hearing or buccofacial apraxia.

Adult↗
PubMed1996

[Crossed aphasia disclosed by central auditory disorder].

A 80-year-old woman, right-handed, suddenly felt the impression to be deaf. Besides, she presented language disorders of aphasic type relating to a sensorial transcortical aphasia. The case meets the diagnostic criteria for crossed aphasia. The magnetic resonance imaging showed a right temporo-parietal infarct. There was no sensorial or peripheral auditive disorder and no auditory agnosia of non verbal modality. During the evolution, the aphasic symptoms diminished partially and the subjective auditory deficit of the left ear continued. The integrated auditory evaluation (neuroacoustic test, study of auditory gnosia, dichotic listening test, evoked cortical auditory potentials) allowed the evidence of the characteristic disturbances of a right hemianacousia: loss of left hear in dichotic audition, decrease of amplitude of evoked right cortical auditory potentials. In the light of theories concerning auditory integration, one can explain this evolution. The initial aphasic comprehension disturbance expresses the alteration of the linguistic treatment of auditory information of the dominant hemisphere, here the right hemisphere. Subsequently, the linguistic disturbance regresses largely, letting persist the change of general auditory treatment. The representation of this general auditory treatment is hemispheric bilateral, the only right hemispheric damage shall result in hemianacousia.

Aged↗
PubMed1997

Lexical-semantic organization: evidence from aphasia.

The emerging field of clinical neuroscience requires the combination of diverse theoretical and methodological approaches to the study of brain function. The study of neurogenic language disorders has played a central role in the development of models of language/brain relationships. These contributions are reviewed with regard to the study of word processing impairments in aphasia, where data from brain-damaged patients has been used to guide the development of models of lexical/semantic organization. It is argued that the study of aphasic patients will continue to occupy a central role in both neuroscience and clinical research as new technologies are developed for functional brain imaging and as theoretically driven treatments for aphasia are designed and tested.

Aphasia↗
PubMed1997

Childhood aphasias.

The study of acquired childhood aphasia has shown that the aphasic syndromes found in adults are reproducible in children with identical lesion sites and that some brain areas are essential for aphasia recovery. Besides, language deficits and learning difficulties are very common in the long-term follow-up of those children. This suggests that the adult pattern of cerebral organization for speech is established early in life and alternative organizations have a lasting price. Yet in contradiction with this, children with focal lesions sustained pre- or perinatally do not show developmentally the aphasic syndromes observed in older children and adults. One possible explanation is that the areas responsible for learning a function are different from those subserving that function as a more mature stage of development. Concerning specific language impairment in children, there is a growing evidence that such syndromes are genetically determined, but there is still a missing link between this predisposition and the structural/functional defects underlying them. The finding that these children are often impaired in other areas of mental development indicates that there may be a more basic cognitive defect underlying their language disorders.

Adult↗
PubMed1997

[Jargon agraphia in a case with Broca aphasia: dissociation between language and writing dominancy].

A 69-year-old left-handed man developed Broca aphasia and jargon agraphia following a right cerebral infarction. He learned to write with his right hand. There is no family history of left-handedness. Neurological examination revealed hemiparesis, sensory impairment, and hyperreflexia with pathological reflexes on the left side. An MRI demonstrated lesions in the area including the pre- and post-central gyri, the posterior part of the middle and inferior frontal gyri, and inferior parietal lobule on the right side. Neuropsychologically he was alert and cooperative. He demonstrated severe Broca aphasia and his verbal output was limited to a few residual words. On the other hand, he could communicate through writing Kanji words. Writing words was relatively preserved with Kanji but not with Kana characters. Asked to write a Japanese folk tale, he showed jargon agraphia mixed with some correct Kanji words. His comprehension of spoken and written sentences was well preserved. He showed mild ideomotor and buccofacial apraxia, left unilateral spatial neglect, and constructional impairment. Dissociation between spoken and written language is a prominent feature of this patient's language output. In this patient, right hemisphere seems to be dominant for language and praxis, and left hemisphere for motor engram of writing. Learning to write with the right hand may have enhanced the establishment and maintenance of motor engram for writing in the left hemisphere. The intact motor engram of characters in the left hemisphere could be retrieved by the right hand without control from the language area in the diseased right hemisphere, resulting in jargon agraphia especially with Kana characters. In left handed people, the hand with which they learn to write may effect interhemisphere lateralization of language functions.

Aged↗
PubMed1997

Primary progressive aphasia, left anterior atrophy, and neurofibrillary hippocampal pathology: observations in an unusual case.

A 71-year-old, right-handed woman experienced onset of a slowly progressive, nonfluent language disorder. She maintained normal cognitive abilities until age 80 and developed a mild spastic right hemiparesis the following year. By age 82, she had become severely demented, mute, and akinetic. Postmortem brain examination showed moderate asymmetric atrophy (wt = 1000 g), which was most prominent in the left perisylvian and posterior frontal regions, with disproportionate enlargement of the left lateral ventricle. Microscopically, a high density of neurofibrillary tangles was present in the hippocampal pyramidal cell layer and entorhinal cortex (up to 45/400 x field, R > L). Gliosis and patchy neuronal loss were symmetrically present in the frontal and parietal lobes including speech areas, but neurofibrillary tangles and neuritic plaques were present in only small numbers (0-1/400 x field). In this case of primary progressive aphasia, pathologic changes associated with Alzheimer's disease occurred in allocortex but not in neocortex. These clinical and neuropathologic findings expand on those previously reported in primary progressive aphasia and suggest a need for further study of this syndrome.

Aged↗
PubMed1976

A neurolinguistic longitudinal study of a pure motor aphasia.

We have made a detailed neurolinguistic study of a patient with motor aphasia. The method used for his reeducation and the variants found in his language from a linguistic point of view through the course of several months are described. During this study we have found similarities with cases studied by Marcie reached by him in the errors common in patients with motor aphasia. But, contrary to Marcies, findings, we have found phonemes and allophones outside of the phonological and/or dilectal system of the language in this area. These phonemes and allophones are described together with the environment in which they appear.

Adult↗
PubMed1997

Outcome measures for aphasia therapy: it's not what you do, it's the way that you measure it.

The development of outcome measures is now seen as crucial within the National Health Service (NHS), and the outcome of aphasia therapy is an area which has for some years been under particular scrutiny. Many districts have developed their own measures and others have taken part in cross-district pilot schemes, but it is not clear how widely used measures are, nor what form they take. This paper presents the results of a questionnaire survey of speech and language therapy services in England and Wales regarding their use of outcome measures for aphasia therapy. The questionnaire requested factual information about the use of measures, and therapists' opinions of their benefits and drawbacks, and also asked for examples of outcome measures currently in use. We summarise the results of the questionnaire and discuss the therapists' and our own perceptions of the merits of the different approaches reported.

Aphasia↗
PubMed1998

[Progressive aphasia without dementia].

INTRODUCTION: Slowly progressive aphasia without generalized dementia is considered as a degenerative disorder that can be differentiated of others well-known neurodegenerative disorders. CLINICAL CASE: We present a case report of a patient with slowly progressive aphasia, characterized by a progressive anomia and without generalized dementia. The patient was evaluated in the last four years: a neuropsychological assessment, a neurological exploration and structural (MRI) and functional (SPECT) neuroimaging were performed. CONCLUSION: This case is interesting on account of a selective implication of the left temporal hemisphere is showed in the pathogenesis of this disorder.

Anomia↗
PubMed1998

The Thai version of the German Aachen Aphasia Test (AAT): description of the test and performance in normal subjects.

The Aachen Aphasia Test (AAT), originally developed as a test for aphasia language disorders in Germany, consists of six spontaneous speech rating scales and five subtests: Token Test, Repetition, Written Language, Confronting Naming and Comprehension. The study aimed to describe the linguistic properties of the AAT Thai version and to investigate the test performances of the normal subjects. In this study some problems of linguistic changes in the construction of the Thai version were discussed. The results revealed that the normal subjects' performances on the test were independent of age, sex and education level. Therefore, the Thai version of AAT is applicable to the differential diagnosis of the communicative abilities of Thai aphasic patients.

Adult↗
PubMed2005

Reaction time and accuracy in individuals with aphasia during auditory vigilance tasks.

Research indicates that attentional deficits exist in aphasic individuals. However, relatively little is known about auditory vigilance performance in individuals with aphasia. The current study explores reaction time (RT) and accuracy in 10 aphasic participants and 10 nonbrain-damaged controls during linguistic and nonlinguistic auditory vigilance tasks. Findings indicate that the aphasic group was less accurate during both tasks than the control group, but was not slower in their accurate responses. Further examination of the data revealed variability in the aphasic participants' RT contributing to the lower accuracy scores.

Acoustic Stimulation↗