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PubMed1999

Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction.

A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.

Affect↗
PubMed2001

Slowly progressive aphasia: a four-year follow-up study.

This paper reports the long-term follow-up of GC, a patient with primary progressive aphasia of the fluent type. GC presented at onset with an anomia characterized by sparing of first letter knowledge, that applied mainly to proper names and living categories. No semantic deficits were observed in the first stage of the disease, and MRI showed a left temporal lobe atrophy with a gradient from the pole to the posterior regions, the latter being less involved. We now report the clinical evolution of GC from the 2nd to the 4th year of disease. As the disease progressed, the anomia became more severe and the phenomenon of first letter sparing was no longer detectable. Also semantic knowledge was gradually affected and, eventually, was dramatically lost. However, no other cognitive deficits were seen at the last examination. By that time, the temporal atrophy shown by MRI was bilateral, although still more evident on the left side.

Aphasia, Primary Progressive↗
PubMed2002

Lexical processing of vocabulary class in patients with Broca's aphasia: an event-related brain potential study on agrammatic comprehension.

This paper presents electrophysiological evidence of an impairment in the on-line processing of word class information in patients with Broca's aphasia with agrammatic comprehension. Event-related brain potentials (ERPs) were recorded from the scalp while Broca patients and non-aphasic control subjects read open- and closed-class words that appeared one at a time on a PC screen. Separate waveforms were computed for open- and closed-class words. The non-aphasic control subjects showed a modulation of an early left anterior negativity in the 210-325ms as a function of vocabulary class (VC), and a late left anterior negative shift to closed-class words in the 400-700ms epoch. An N400 effect was present in both control subjects and Broca patients. We have taken the early electrophysiological differences to reflect the first availability of word-category information from the mental lexicon. The late differences can be related to post-lexical processing. In contrast to the control subjects, the Broca patients showed no early VC effect and no late anterior shift to closed-class words. The results support the view that an incomplete and/or delayed availability of word-class information might be an important factor in Broca's agrammatic comprehension.

Adult↗
PubMed1997

Memory and aphasia.

Sixty-one acute and 17 chronic vascular left-hemisphere damaged patients were tested with five memory tasks that investigated verbal short-term (digit span) and long-term (paired-associate and story learning) memory, and spatial short- and long-term memory (Corsi's span and learning). Both brain-damaged groups were significantly impaired in all memory tasks (except for chronic patients in the story learning task) compared to normal controls. The presence of aphasia and locus of lesion (anterior, posterior and deep) had no effect on the memory impairment, with only one exception of paired-associate learning that was better performed by non-aphasic than aphasic patients. Eleven subjects were better at paired-associate learning than story recall, the reverse dissociation was never found. Finally, chronic patients performed significantly better than acute patients only in the Corsi's learning task.

Acute Disease↗
PubMed1998

Understanding ambiguous words in sentence contexts: electrophysiological evidence for delayed contextual selection in Broca's aphasia.

This study investigates whether spoken sentence comprehension deficits in Broca's aphasics results from their inability to access the subordinate meaning of ambiguous words (e.g. bank), or alternatively, from a delay in their selection of the contextually appropriate meaning. Twelve Broca's aphasics and twelve elderly controls were presented with lexical ambiguities in three context conditions, each followed by the same target words. In the concordant condition, the sentence context biased the meaning of the sentence-final ambiguous word that was related to the target. In the discordant condition, the sentence context biased the meaning of the sentence-final ambiguous word that was incompatible with the target. In the unrelated condition, the sentence-final word was unambiguous and unrelated to the target. The task of the subjects was to listen attentively to the stimuli. The activational status of the ambiguous sentence-final words was inferred from the amplitude of the N400 to the targets at two inter-stimulus intervals (ISIs) (100 ms and 1250 ms). At the short ISI, the Broca's aphasics showed clear evidence of activation of the subordinate meaning. In contrast to elderly controls, however, the Broca's aphasics were not successful at selecting the appropriate meaning of the ambiguity in the short ISI version of the experiment. But at the long ISI, in accordance with the performance of the elderly controls, the patients were able to successfully complete the contextual selection process. These results indicate that Broca's aphasics are delayed in the process of contextual selection. It is argued that this finding of delayed selection is compatible with the idea that comprehension deficits in Broca's aphasia result from a delay in the process of integrating lexical information.

Aged↗
PubMed2000

The role of speech production in auditory-verbal short-term memory: evidence from progressive fluent aphasia.

We report investigations of auditory-verbal short-term memory (AVSTM) in a patient with progressive fluent anomic aphasia. Despite having apparently normal AVSTM as measured by digital span, FM was significantly impaired in immediate serial recall of short sequences of familiar words, and even in reproducing a single word after a filled delay of just a few seconds. In both tasks, unlike normal subjects, she produced numerous phonological errors, often consisting of phonological segments from the intended target word concatenated with segments from other words in the stimulus sequence. Her success in these tasks was modulated (i) consistently by word frequency (high > low), (ii) inconsistently by word imageability (high > low), and (iii) most dramatically by 'nameability': that is, FM was much more likely to reproduce a word correctly in AVSTM if it was a word that she could also produce successfully in picture-naming tasks. On the basis of these and additional experiments designed to exclude other interpretations, we conclude that AVSTM may be crucially supported by activation of the lexical phonological representations responsible for production of content words in speech.

Anomia↗
PubMedDate not supplied

Primary progressive aphasia. An uncommon masquerader of psychiatric disorders.

Primary progressive aphasia is a recently described, uncommon language disorder with unclear etiological and clinical boundaries. The infrequency and ambiguity of the syndrome may prompt psychiatric consultation. The authors review the pertinent features of one such referral, including a brief literature review of the salient aspects of the differential diagnosis, and note the implications for appropriate treatment.

Agnosia↗
PubMed2004

[Communication disorders after decline in sub-cortical aphasia: the role of fronto-sub-cortical disconnection?].

INTRODUCTION: Pragmatic analysis of Language difficulties examines the pertinence and adaptation of the spoken Language which can be disturbed even when phonologic, syntactic and semantic functions, taken separately, appear normal. Disorders of pragmatic Language function remain poorly explored and the few published papers in adult neuropsychology have been devoted to patients with traumatic frontal lesions. METHODS: In the present study we report the case of a patient admitted for right hemiplegia with "dissident" aphasia related to a capsulo-lenticular hematoma. Aphasic disorders progressively improved but with the occurrence of speech disorders which were assessed by pragmatic indices. RESULTS: There was no difference between free and directed interview with the exception for the non-contingencies which were significantly more frequent in the directed interview. As compared with the spoken Language of a normal individual, highly significant differences were noted for incoherent lexical proximities, non-contingencies and markers of difficulty. DISCUSSION: and conclusion. For some Authors, the pragmatic speech disorders observed in this patient during the directed interview are linked to abnormal executive functions, also noted in the patient. The difficulties to adjust to speech constraints of the interview context could be related to a fronto-subcortical disconnection resulting in this patient to the left capsulo-lenticular lesion.

Aphasia, Broca↗
PubMed2003

Acute conduction aphasia: an analysis of 20 cases.

In this study, the linguistic performance of 20 patients with acute conduction aphasia (CA) is described. CA presented as a relatively homogeneous aphasic syndrome characterized by a severe impairment of repetition and fluent expressive language functions with frequent phonemic paraphasias, repetitive self-corrections, word-finding difficulties, and paraphrasing. Language comprehension as assessed by tests of auditory and reading comprehension was only mildly impaired, whereas most patients performed poorly on the Token Test. Verbal-auditory short-term memory was reduced in all patients except one and seems to play a role in associated cognitive deficits, such as impaired syntactic comprehension or reduced mental arithmetics. A follow-up examination of 12 patients showed that CA often resulted in a chronic language deficit. Lesion locations were the posterior temporal and inferior parietal lobe.

Acute Disease↗
PubMed2003

Phoneme frequency effects in jargon aphasia: a phonological investigation of nonword errors.

This study investigates the nonwords produced by a jargon speaker, LT. Despite presenting with severe neologistic jargon, LT can produce discrete responses in picture naming tasks thus allowing the properties of his jargon to be investigated. This ability was exploited in two naming tasks. The first showed that LT's nonword errors are related to their targets despite being generally unrecognizable. This relatedness appears to be a general property of his errors suggesting that they are produced by lexical rather than nonlexical means. The second naming task used a set of stimuli controlled for their phonemic content. This allowed an investigation of target phonology at the level of individual phonemes. Nonword responses maintained the English distribution of consonants and showed a significant relationship to the target phonologies. A strong influence of phoneme frequency was identified. High frequency consonants showed a pattern of frequent but indiscriminate use. Low frequency consonants were realised less often but were largely restricted to target related contexts rarely appearing as error phonology. The findings are explained within a lexical activation network with the proposal that the resting levels of phoneme nodes are frequency sensitive. Predictions for the recovery of jargon aphasia and suggestions for future investigations are made.

Aged↗
PubMed2003

Neurological basis of language and sequential cognition: evidence from simulation, aphasia, and ERP studies.

The current research addresses the hypothesis that certain aspects of sequential cognition have made substantial contributions to the human language processing capability, from a functional neurophysiology perspective. We first describe a cognitive sequence processing model that was developed based on the functional neuroanatomy of primate cortex and basal ganglia. We demonstrate how this model is capable of simulating the behavior of human infants in extracting serial, temporal and abstract structure from language-like sound sequences as revealed in recent psycholinguistic experiments. We then demonstrate how, through training, this model can perform adult level syntactic comprehension, based on dissociated processing streams for open vs. closed class words. The model subsequently predicts: (1) that impaired syntactic processing (as in agrammatic aphasia) will be associated with impairments in corresponding non-linguistic cognitive sequencing tasks, and (2) that neurophysiological processes (as revealed by ERPs) involved in syntactic processing should also be involved in the corresponding non-linguistic cognitive sequencing tasks. Data confirming these predictions are reviewed. We conclude that the study of sequential cognition will provide a new paradigm for the investigation of the neurophysiological bases of language.

Aphasia, Broca↗
PubMed2004

The resolution and recovery of filler-gap dependencies in aphasia: evidence from on-line anomaly detection.

This study examines the on-line processing of sentences with movement using an auditory anomaly detection task (after Borland, Tanenhaus, Garnsey, & Carlson, 1995). Eight agrammatic aphasic participants (four of whom had undergone treatment focused on comprehension and production of filler-gap sentences) and 24 young normal participants listened to sentences and pressed a button when the sentences "stopped making sense." Critical sentences contained an anomaly in object relative clauses or conjoined clauses. Results showed that both young normals and aphasic participants were able to reject anomalous sentences of both types. In addition, both groups showed evidence of filler-gap resolution on-line. Importantly, however, there was evidence of a treatment effect for the aphasic patients: those who received treatment showed better performance than those who had not. Treated patients were more successful than the untreated patients in detecting the anomaly in filler-gap conditions, rejecting the anomalous filler-gap sentences reliably more often than the non-anomalous ones, like the young normals. This effect was not noted for untreated participants, i.e., there was no statistical difference between their rejection of anomalous and non-anomalous filler gap sentences. Further, the reaction time data showed that the treated aphasic patients' rejections came before sentence's end (within 2000 ms), while the majority of responses made by untreated patients did not. These results indicate that individuals with agrammatic aphasia appear to retain some gap-filling capacity and that treatment can improve their ability to make use of this capacity.

Adolescent↗
PubMed2000

Persisting aphasia as the sole manifestation of partial status epilepticus.

OBJECTIVES: Persisting aphasia presenting as an isolated inability to vocalize is an uncommon presentation of simple partial status epilepticus and only eight such cases have been reported over the past 40 years. METHODS: We studied a patient with a 5-year history of recurrent episodes of inability to talk, without any other motor or cognitive impairments. Episodes lasted as long as 24 h, interictal EEGs were normal and she was diagnosed as a conversion disorder. RESULTS: EEG recordings during one of the episodes showed continuous discharges in the right frontal and parasagital areas demonstrating the ictal nature of the deficits. During the episode the patient had no deficits of strength, or in her ability to perform skilled movements to command, imitation or manipulation of objects. Comprehension of complex verbal commands was preserved and she would make attempts to articulate words and correctly answered questions with head nodding or monosyllables, yes or no. She could hum but had no other vocalizations. CONCLUSIONS: This is the first case of aphasic status epilepticus secondary to epileptogenic discharges of the right hemisphere. The case is also unique for the isolated involvement of production of language during the seizure.

Aged↗
PubMed2001

Recurrent hypoglycemic hemiparesis and aphasia in an adolescent patient.

A 12-year-old diabetic female with right-side hemiparesis and aphasia occurring after a hypoglycemic episode is reported. Her clinical course improved over a 24-hour period, and further investigation revealed only electroencephalographic slowing, which was more prominent on the left. Ten months later, she had a recurrence of the same symptoms, which also resolved rapidly. This potential complication of hypoglycemia is often mistaken for a cerebrovascular accident.

Adolescent↗
PubMed2007

Aphasia: an early uncommon complication of ovarian stimulation without ovarian hyperstimulation syndrome.

Thromboembolic disease associated with assisted reproductive techniques is extremely rare. A 21-year-old woman with primary infertility underwent an ovulation induction cycle with luteal long protocol. Twenty-four hours following oocyte retrieval, the patient complained of difficulty in speaking. On neurological examination, mild disorientation, motor aphasia, and right-sided hypoesthesia were noted. Brain computed tomography scanning without contrast revealed left parietal lob infarct. Brain magnetic resonance imaging (MRI), MRI angiography (MRA) and perfusion MRI demonstrated an occlusion of the posterior division of the left middle cerebral artery (MCA). Physical, ultrasound examinations and laboratory test evaluation failed to reveal ovarian hyperstimulation syndrome. Except for ovarian stimulation, no additional risk factors for stroke were shown. Following anticoagulation and speech therapy, the patient recovered completely within eight months. One year after the left MCA thrombosis, she conceived spontaneously and had an uncomplicated vaginal delivery of a live male infant weighing 2900 g at 38 weeks gestation. This case supports that ovulation induction and assisted reproductive techniques may be a newly recognized cause of cerebral infarction in otherwise healthy women.

Adult↗
PubMed2006

Postictal aphasia with transient sulcal hyperintensity on MRI.

A 38-year-old man had postictal global aphasia after generalized tonic-clonic seizure, but recovered within 1 day. There was a focal increase in the signal intensity of the left frontoparietal sulci on fluid-attenuated inversion recovery magnetic resonance (MR) sequence 6 hours after the seizure, which disappeared 1 month later. The transient seizure-induced MR hyperintensity was possibly caused by ictal or postictal hyperemia and breakdown of the blood-brain barrier. This report aims to increase awareness of this condition and avoid unnecessary management.

Adult↗
PubMed1994

Unilateral Creutzfeldt-Jakob disease presenting as rapidly progressive aphasia.

A 64-year-old man presented with a three day history of progressive Broca's aphasia, followed within 3 weeks by exclusively right-sided myoclonus, rigidity, and dystonia. Within 4 weeks he was globally aphasic. He died within 7 weeks of onset. In the final week, rigidity and myoclonus became bilateral. CT and MRI were normal. SPECT showed diminished perfusion of the left hemisphere. EEG showed periodic discharges on the left. At autopsy, there were marked cortical spongiform change, neuronal loss, and gliosis throughout the left hemisphere and in the right occipital cortex. Elsewhere in the right hemisphere, spongiform change was non-existent to minimal. There was moderate spongiform change in the molecular layer of the cerebellar cortex, much more marked on the left. Clinical and pathological unilateral cerebral predominance extended to the ipsilateral cerebellum. Creutzfeldt-Jakob disease is an important consideration in patients with rapidly progressive unilateral cerebral signs associated with a movement disorder.

Aphasia, Broca↗
PubMed2004

The aphasia quotient: the taxonomic approach to measurement of aphasic disability. 1974.

150 aphasiacs and 59 controls were examined with a scorable, comprehensive battery, designed to be used by the clinician and the research worker. The subtests of Fluency, Information, Comprehension, Repetition and Naming were added and compared to a hypothetical normal of 100 obtaining the "aphasia Quotient." This is a measurement of the severity of language impairment. On the basis of their performance on the subtests, the patients were classified according to taxonomic principles into Global, Motor (Broca's), Isolation, Sensory (Wernicke's), Transcortical Motor, Transcortical Sensory, Conduction and Anomic groups (in order of severity). This classification is considered a clinically valid baseline for research, diagnosis and prognosis.

Aged↗