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Four children with aphasia-epilepsy syndrome are reported with special emphasis on the EEG. Midtemporal spike activity (more on the left) and bilateral-synchronous bursts of spikes and slow spike-wave complexes are the outstanding EEG characteristics of this syndrome.
Most patients with motor aphasia resulting from lesions of the left frontal opercular region have weakness of the right face and arm. We report a 43-year-old man who suffered mutism and agraphia unaccompanied by right-sided weakness after embolic infarction of Broca's area.
In two patients with Wernicke's aphasia, both oral reading and reading comprehension were relatively preserved despite total destruction of Wernicke's area. The pattern of oral reading suggested an intact ability to derive phonology directly from print; the pattern of reading comprehension implied at least partial ability to interpret syntactic constructions. These features are not readily compatible with current notions of right hemisphere function and may suggest that undamaged left hemisphere structures mediated residual reading in these patients.
A strongly right-handed man developed sudden mutism and left hemiplegia 2 days after a myocardial infarct. Evaluation 6 1/2 years later revealed persistent Broca's aphasia. There was no clinical, CT, or EEG evidence of left brain injury or disease. This case is another example of dissociation of cerebral dominance for speech and handedness. However, the severe and persistent language disorder is rare. The paucity of documented case reports supports the traditional view of strong interdependence of handedness and speech cerebral lateralization.
We studied eight children with acquired aphasia. All had left hemisphere lesions. In most, the correlation between the CT lesion site and the resulting aphasic syndrome duplicated an anatomic-clinical correlation described in adults. Rapid recovery of language fluency distinguished the children from reported adults. Late follow-up indicated poor scholastic achievements, reflecting an acquired handicap in new learning. Anatomic-clinical correlates and recovery patterns suggest that brain organization for language is similar but not identical in children and adults.
Three of 50 patients with left hemisphere stroke manifested Broca's aphasia associated with deficits in syntactic processing. CT demonstrated anterior infarcts in two patients and a posterior infarct in the third. Two years later, all three patients showed improved syntactic production, but only the patient with the posterior lesion performed significantly above change on a sentence comprehension test requiring syntactic manipulations in the absence of semantic constraints. Prospective investigations combining psycholinguistic analyses and brain imaging techniques may provide empiric data relevant to neurologic models of language and ultimately may contribute to patient prognostication and rehabilitation.
The effects of a generalization training procedure on requesting by 4 subjects with chronic Broca's aphasia were examined using a multiple baseline design across behaviors and subjects. Subjects were trained to request information on three topics sequentially. Generalization across topics and persons was assessed in weekly probe sessions consisting of 5-min conversational interactions with trainers and unfamiliar volunteers in a nontreatment setting. Results revealed generalization effects were greatest when trainers, as opposed to unfamiliar volunteers, served as conversational participants. Nevertheless, subjects' requests increased with all conversational participants to a level comparable to a normal comparison group assessed under conditions identical to the experimental probes. Social validation of treatment effects using a subjective evaluation procedure revealed significant improvement on the parameters of talkativeness, inquisitiveness, and conversational success.
The effects of auditory-visual stimulation treatment derived from principles associated with a stimulation approach for aphasia treatment and direct-production treatment derived from a behavioral or learning approach were examined in 4 neurologically stable agrammatic aphasic subjects. Subjects were trained to produce selected exemplars of wh interrogative morphemes in complete sentence contexts, while the acquisition, response generalization (both within and across interrogative forms), stimulus generalization (to language samples), and maintenance effects of the two treatments were assessed. An alternating treatments design (ATD) in combination with a multiple-baseline design across behaviors and a multiple-baseline design across subjects was employed. Interrogative constructions were counterbalanced across subjects and treatments, and probes were administered daily to assess treatment effects. Results indicated that direct-production treatment was consistently more effective than auditory-visual stimulation treatment in facilitating acquisition of target responses for all subjects. Response generalization within interrogative forms paralleled acquisition regardless of treatment approach. Stimulus generalization to the elicited language-sample condition was not evident, however, trained responses were maintained subsequent to treatment. These data provided support for using direct-production treatment for interrogative intervention with agrammatic aphasic patients and indicated that training a selected number of exemplars of target interrogatives results in generalization of that question form to novel language responses. However, the lack of generalization across interrogatives indicated that wh interrogatives do not constitute a response class and, thus, pointed out a need for programming generalization to untrained members of that linguistic class and to spontaneous language.
27 cases of patients who presented language disorders of aphasic nature consecutive to a strictly subcortical lesion of vascular origin are reported. From a topographic point of view, the population is divided into 3 groups: thalamic lesions (15 cases), striatal lesions (9 cases), isolated lesions of the white matter (3 cases). The results of the neurolinguistic analysis of the aphasia show a great symptomatological variety. Nevertheless, in spite of this apparent diversity, certain semiologic elements appear to be common to all of the observed linguistic profiles, no matter where the lesion is: hypophonia, non fluent speech, verbal paraphasias, normal repetition, comprehension generally good. A discussion is proposed as to the specific part which certain structures, notably the thalamus, might play in the origin of these various disturbances.
A 16 year boy with subacute sclerosing panencephalitis in stage 4 is described. Neuropsychological analysis reveal a transcortical sensorial aphasia. Behavior therapies of shaping and fading are proposed.
Two patients suffering from a left thalamus infarct were studied over a long period. The precise location of the lesion has been demonstrated by the C.T. scan. In spite of the absence of any cortical lesion, both presented with aphasia and other neuropsychological disorders (left-right confusion, dyscalculia and possible finger agnosia). Their speech disorders although different, had several features in common. The observations were compared with the other cases reported in the literature.
A longitudinal case study of a patient with a progressive loss of meaning of objects with preserved phonology and syntax is presented. Repeated measures of language, praxis, visual cognition, and semantic processing were carried out. The patient still has preserved conversational speech, social skills, and orientation in her 8th year of her illness, but shows severe anomia and comprehension deficit in all modalities of stimulus presentation. In addition to standardized tests of language, cognition, and memory, specific experiments of categorization, modalities of word access, item consistency, category specificity, and definition of words were carried out. Results indicate a frequency dependent loss of meaning that was consistent in all modalities and throughout all object categories. However, the relative preservation of visual categorization of all categories tested and the language based categorization of animals suggested some fractionation of semantic memory. Relative preservation of autobiographical and personal memories versus semantic memory was a striking observation. Evidence for selective impairment of central semantic processing was obtained from experiments indicating item consistency of loss and the lack of semantic cuing. Neuroimaging evidence of left temporal lobe atrophy and the classical picture is compatible with similar cases published under the term semantic dementia or "transcortical sensory aphasia with visual agnosia" and suggest the diagnosis of Pick's disease.
A 30-year-old man was admitted to the hospital with a history of sudden onset of bizarre behavior and difficulty in speaking that initially was attributed to drug intoxication. Examination disclosed a confused young man with receptive and expressive aphasia. A late systolic murmur was heard in the mitral area and echocardiography confirmed the presence of mitral valve prolapse. A computed tomographic scan of the head and cerebral angiography showed abnormalities consistent with an infarct of the left temporo-occipital region. Since no other predisposing factors were present, this patient's stroke was probably related to mitral valve prolapse.
Wernicke is usually credited with the first significant description of comprehension disorders in aphasia. Before Wernicke, however, others had reported patients with impaired comprehension. This communication deals with one of those pioneer papers, that written by Schmidt, an obstetrician, in 1871. It concerns a 25-year-old woman who developed sudden language difficulty ten days after delivery. She had trouble understanding oral or written language. Through careful examination, Schmidt showed that she was neither deaf nor psychotic. He concludes his paper with a prediction of the area of the brain he suspected to be involved. Schmidt's paper represents an early, noteworthy effort to clarify the relations between brain and behavior.
A persistent nonfluent aphasia following a right cerebral infarction developed in a 54-year-old right-handed Chinese man. Computerized axial tomography localized the lesion in the distribution of the right middle cerebral artery. The speech and language dysfunction was greater for performances in Chinese than in English, despite the fact that the patient was born in China, was schooled in Chinese until age 7, and spoke Chinese at home and in his business. It is suggested that early learning of Chinese, an ideographic language based on visual spatial percepts, might have been critical for the establishment and maintenance of language dominance in the right hemisphere.
A 62-year-old right-handed woman was admitted to the hospital with a cerebrovascular accident in the left hemisphere. She was aphasic as well as hemiplegic on the right. She had had a left cerebrovascular accident 18 years earlier that caused weakness in the right hand, but no grossly detectable speech problems. Autopsy disclosed an old infarct along the left Rolandic area, and a recent infarct in the territory of the left anterior cerebral artery. The clinical picture and pathologic changes are discussed in an attempt to relate the findings at autopsy to the recently developed aphasia.
In a 35-year-old right-handed man who had no personal or family history of left-handedness, left hemiparesis and predominantly motor aphasia suddenly developed following cerebrovascular accident. Clinical and laboratory data, including computerized tomographic scan, showed a clearly defined right hemisphere lesion. On dichotic listening test, a clear-cut right ear extinction was present.
We studied a case of language loss caused by an acquired vascular lesion in the putamen, anterior limb of the internal capsule, and lateral aspect of the head of the caudate nucleus in a 7-year-old right-handed girl. Acute right-sided hemiplegia, mutism, oral apraxia, and disturbance in language comprehension but no dysarthria were present. During recovery, a nonfluent aphasia with anomia was evident. After six months, only mild hemiparesis and minor spelling difficulties persisted. We compared this patient with an 11-year-old right-handed girl with right-sided hemiparesis and dysarthria but no language loss following a lesion in the globus pallidus, a portion of the posterior limb of the internal capsule, and the body of the caudate. The presence of a language disturbance in the first but not the second patient was attributed to the difference in lesion location. The symptoms and lesions were similar to those in recent reports of adult patients. To our knowledge, this is the first report of these findings in a child with a left-hemisphere lesion.