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We report a case of Sjögren-Larsson syndrome with spastic diplegia and conduction aphasia. MRI demonstrated the white matter changes deep in the cerebral hemispheres. We analyse the MRI findings and compare the results with neuropsychological signs.
This study examines agrammatic comprehension of object-subject-verb (OSV) and object-verb-subject (OVS) structures in Hebrew. These structures are syntactically identical to the basic order subject-verb-object (SVO) sentence except for the movement of the object to the beginning of the sentence, and thus enable empirical examination of syntactic movement in agrammatic comprehension. Seven individuals with agrammatism, 7 individuals with conduction aphasia, and 7 individuals without language impairment, all native speakers of Hebrew, performed a sentence-picture matching task. The task compared OSV and OVS sentences to SVO sentences and to subject and object relatives. Individuals with agrammatism performed more poorly than those in either of the other groups. Their comprehension of SVO sentences was significantly above chance, but comprehension of OSV and OVS sentences was at chance and was poorer than comprehension of SVO sentences. These results show that agrammatic comprehension of structures that involve movement of a noun phrase is impaired even when the structure is a simple active sentence, in line with the Trace Deletion Hypothesis (TDH; Y. Grodzinsky, 1990, 1995a, 2000). A modification is suggested to accommodate the TDH with the VP Internal Subject Hypothesis, according to which individuals with agrammatism use an "Avoid Movement" strategy in comprehension.
We report a case of non-fluent conduction aphasia. The patient was a 59-year-old right-handed male. He suffered from aphasia after a left internal carotid artery occlusion. MRI study revealed subcortical lesions in the left inferior frontal gyrus and cortical lesion in the anterior part of the left insular gyrus and the left postcentral gyrus. The patient showed good comprehension of words and daily conversation but had a common difficulty in the following tasks; naming of pictures, repetition of words, reading of kanji and kana letters. In these tasks, the phonological output of the patient contained many literal paraphasias and there was a tendency that errors appeared more in the posterior portion of a target word. We analyzed the position of errors in the target word on word repetition tasks. The result confirmed the above observation. We speculate that the length of a target word may have played a critical rote in this patient's repetition capability.
The purpose of this study was to identify the nature of the deficit for a conduction aphasic patient in order to evaluate two different theories of conduction aphasia. First, a conduction aphasic patient FS was tested on auditory word-pair discrimination, word-repetition, and picture-naming. The results of these tasks indicated that her deficit was likely to be post-lexical rather than perceptual or lexical. Next, we examined her repetition performance for two types of nonwords (high-wordlike and low-wordlike nonwords) to distinguish the two theories. FS exhibited a wordlikeness effect: she produced more correct moras and more correct combinations of moras for high-wordlike nonwords than low-wordlike nonwords. We conclude that she had difficulty in maintaining stable phonological representations of verbal materials in the output buffer.
Recent progress of imaging techniques has achieved precise descriptions of aphasic syndromes associated with cerebrovascular disorders. Infarction of the left anterior cerebral artery brings about transcortical motor aphasia. Occlusion of each branches of the left middle cerebral artery produces characteristic language symptoms. Recently, cases with infarction of the areas of prefrontal and precentral arteries were reported to manifest fluent aphasia indistinguishable from the classical transcortical sensory aphasia. Rare cases with lesions restricted to the Broca's area (territory of the precentral artery) produces aphasia with normal fluency, word finding difficulty and deficit in sentence comprehension. Classical non-fluent Broca's aphasia is caused by infarctions which at least involves the areas of precentral and central arteries. Aphemia or pure word dumbness results from damages which involves territory of the central artery. Conduction aphasia is most often associated with lesions of the posterior parietal artery territory. As in the case of Broca's aphasia, Wernicke's aphasia is a composite of conduction aphasia, pure word deafness, transcortical sensory aphasia, and alexia with agraphia. The lesion of Wernicke's aphasia naturally involves the areas of all of these aphasic symptoms. Transcortical sensory aphasia is associated with lesions in the posteroinferior temporal region, and is often associated with watershed infarctions of the middle and posterior cerebral arteries. Aphasia which results from putaminal hemorrhage has ambiguous manifestation, and is difficult to be classified into Wernicke-Lichtheim's model. Assessment of its fluency is notoriously difficult. Thalamic aphasia is similar to either anomic aphasia or transcortical sensory aphasia. It was pointed out that classical aphasic syndromes are still valid as cerebral arterial occlusion syndromes, but are insufficient for the purpose of more precise anatomo-clinical correlation.
We studied seven patients with left cerebral atriovenous malformation (AVM) with superselective arterial injection of anesthetics during angiography to determine whether there was translocation of some language functions to other regions in the ispilateral hemisphere. All patients were right handed. With a catheter inserted into each target vessel, patients underwent aphasia examination in an A-B-A design: (A) baseline, no anesthetic; (B) 1 minute after anesthetic injection; and (A) 12 minutes after injection (when its effects had dissipated). The results showed that six of seven patients had no significant aphasia at baseline or 12 minutes after anesthetic injection. One patient had a mild conduction aphasia at baseline and after anesthetic effects had dissipated. In the six patients with temporoparietal AVM, anesthetic injections into vessels in the lower division of the middle cerebral artery (MCA) not feeding the AVM (e.g., the left angular artery) produced a wide range of language function--from conduction aphasia to dense Wernicke's syndromes. When upper division MCA vessels were injected (e.g., the prefrontal branch), all developed a major aphasic disorder with significant comprehension defects. A seventh patient with a frontal opercular AVM had a mild anomia, semantic paraphasias, and decreased word-list generation when the prefrontal branch was injected. Her comprehension, however, was intact. These data show that patients with posterior cerebral AVM can show language abnormalities where such deficits are not typically seen after acute brain injury. These findings support a posterior-to-anterior extension of some language skills under conditions of brain disease.
There is considerable variability among epilepsy centers in the methods and interpretations of the intracarotid amobarbital procedure. Prominent among these differences is the determination of language representation and assessment of language functions. Some centers rely on speech arrest following amobarbital injection as a marker for language representation, whereas other centers examine verbal output for the presence of aphasic errors. The present study assessed the pattern of language recovery following amobarbital injection in epilepsy patients who were candidates for temporal lobectomy. Language recovery from dominant hemisphere injection (left or right) followed a stereotypical progression, with 71.8% of patients showing return of vocalization followed by return of naming and comprehension. Repetition deficits with paraphasic errors persisted the longest (mean = 12'30"), with a conduction aphasia persisting after the acute global aphasia resolved. Although two patients interpreted as left hemisphere language dominant were mute following right hemisphere injection, all language functions were intact immediately upon resumption of vocalization and they showed no other signs of aphasia such as paraphasias or anomia. Possible explanations for serial language recovery and persistent conduction aphasia are discussed. These findings have significant implications for the determination of cerebral language dominance.
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.
This study investigated the isometric force and static position control of the upper lip, lower lip, tongue, jaw, and finger in four subject groups (normal control, apraxia of speech, conduction aphasia, and ataxic dysarthria) at two force and displacement levels. Results from both the force and position tasks suggested that the apraxic and dysarthric groups tended to produce significantly greater instability than the normal group, although the pattern of instability across articulators was not systematic within or across the force and position experiments for subjects within or between groups. The conduction aphasic group produced force and position stability that typically was not significantly different from any of the remaining three groups, suggesting that their force and position stability as indexed in the present study fell somewhere between that of the normal group and the apraxic and dysarthric groups. It is suggested that other analyses of force and position control, such as descriptive accounts of the trial-by-trial time histories, might shed additional light on the speech and orofacial sensorimotor control deficits in persons with apraxia, dysarthria, and conduction aphasia.
Short-term memory was investigated in 30 control and 125 unilaterally brain-damaged patients with a series of tests requiring the immediate reproduction of strings of items of increasing length. In three tests the items were auditorially presented digits or words: one test asked for oral repetition of digits, while the other two required the patient to point to written digits or to pictures. The fourth test aimed at measuring spatial span. On both the Digits Forward test and the two other verbal tests not requiring the use of speech, left brain-damaged patients were impaired in comparison to normals, while the right brain-damaged patients were not. Aphasics had a significantly shorter verbal span than non-aphasic patients with left hemisphere damage. Spatial span, on the other hand, was significantly affected by a lesion posteriorly located in either hemisphere, but not by aphasia. Two patients with an exceedingly poor verbal memory span were observed, one suffering from anomic aphasia and the other from conduction aphasia. There were also two right hemisphere damaged patients who showed an extreme reduction of spatial span, which could not be accounted for by space perceptual disorders and contrasted with a normal performance on a spatial long-term memory test.
Five children (three males, two females; four right-, one left-handed; age range 6 to 14 years) who developed aphasia after gross-total excision of left predominantly thalamic tumors are reported. Three patients had Broca aphasia, one had mixed transcortical aphasia, and one patient had conduction aphasia. In the months after surgery, three children improved while receiving radiation and/or chemotherapy, although none recovered completely. Two patients with malignant tumors developed worsening aphasia when the tumor recurred, and later died. Two of three patients tested had visuospatial difficulties in addition to language deficits. Attention and executive functioning were affected in three of three patients tested. Memory, verbal and/or visual functioning, were affected in four of four patients tested. Both patients who were tested showed transient right hemineglect. Two of two patients tested were probably apraxic. The wide range of deficits in these children highlights the importance of the thalamus and other subcortical structures in developing cognition.
Twenty five cases of subcortical aphasia of vascular origin (15 haemorrhagic, 10 ischaemic), have been studied in detail by means of neurolinguistic and brain-scanning approaches. The neurolinguistic investigation allowed three groups to be distinguished. Group 1 comprised 4 cases of dysarthria. Group 2 was made up of 9 classical syndromes of aphasia: 2 global aphasias, 3 Broca's aphasias, 3 cases of Wernicke's aphasia and 1 case of conduction aphasia. Group 3 consisted in 12 unusual aphasic syndromes, i.e. 2 mixed aphasias and 10 cases which did not correspond with any traditional semiological description and are spoken of as "dissident" (or anomalous) cases. The CT scan results revealed a wide range of focal lesions for the same clinical syndrome; the 10 "dissident" cases were, in particular, associated with a large variety of lesions. After a discussion of the anatomical limits of the subcortical lesions, 2 points emerge: 1) in the current state of technological experience no anatomo-clinical correlation can be drawn as regards language-deficiencies of subcortical origin. 2) in almost half the cases a "unique" syndrome of aphasia has been observed and described, which at first might suggest the diagnosis of a subcortical lesion.
A case of jargon writing following a right vascular cortico-subcortical lesion in the right sylvian territory of a strictly right-handed patient is presented and analyzed. In spontaneous writings the general graphic form of sentences is present (blanks, punctuation) but a great number of neologisms appear. Disorganisation of oral language in this case of crossed aphasia takes the form of a conduction aphasia. The patient is capable of oral spelling and of writing single letters under dictation. If he is asked to spell orally a dictated word while attempting to write it, his writing is much improved. This observation is contrasted with that of an agraphic patient whose writing is limited to concrete nouns. The analysis of the data obtained confirms the existence of different strategies of graphic encoding recently described in various neuropsychological studies: the agraphia of the crossed aphasic patient is related to the lexical form, that of the second patient is related to the phonological form.
A parallel distributed processing (PDP) model of phonological processing is developed, including components to support repetition, auditory processing, comprehension, and language production. From the performance of the PDP reading model of Plaut, McClelland, Seidenberg, and Patterson (1996), it is inferred that the acoustic-articulatory motor pattern associator that supports repetition provides the basis for phonological sequence knowledge. From the observation that many patients make phonemic paraphasic errors in language production, as in repetition, it is argued that there must be a direct link between distributed concept representations (lexical semantic knowledge) and this network representation of sequence knowledge. In this way, both lexical semantic and phonotactic constraints are brought to bear on language production. The literature on phonological function in normal subjects (slip-of-the-tongue corpora) and in patients with aphasia is critically reviewed from this perspective. The relationship between acoustic and articulatory motor representations in the process of phonetic perception is considered. Repetition and reproduction conduction aphasia are reviewed in detail and extended consideration is given to the representation of auditory verbal short-term memory in the model. Finally, the PDP model is reconciled with information processing models of phonological processing, including that of Lichtheim, and with current knowledge of the anatomic localization of phonological processing. Although no simulations of the model were run, a number of simulation studies are proposed.
A 55-years-old man with a history of alcoholism, hypertension and obesity was diagnosed of epidermoid carcinoma of the middle third portion of the esophagus. He was treated with two cycles of cytostatics with cisplatin and 5-fluorouracil. Due to his poor general health an inability to swallow solids and liquids, he received parenteral nutrition for 20 days using a commercial formula lacking in vitamins and minerals. During distal esophagectomy we observed a tendency to hypotension and severe metabolic acidosis that was unexplained by the hemodynamic profile and that persisted throughout the first 24 hours after surgery. Once these complications were corrected, he was weaned from mechanical ventilation and the following neurological signs were observed: temporal and spacial disorientation, aphasia, ophthalmoplegia with divergent strabismus and later conduction aphasia, amnesia and confabulation. Circulation was hyperdynamic, requiring inotropics and vasoconstrictors. Korsakoff syndrome secondary to Wernicke's encephalopathy was diagnosed, and the response to thiamine treatment was favorable. Beriberi can be found in hospitalized patients and the anesthesiologist may be involved in their perioperative care. Symptoms resolve easily with vitamin B1 treatment, which is ideally provided along with other hydrosoluble vitamins. Treatment should be prompt because delay leads to greater morbiomortality.
A 64-year-old right-handed woman with no left-handers in the family developed aphasia associated with moderate left hemiparesis and dense left homonymous hemianopia following rupture of a right middle cerebral artery aneurysm and subsequent selective surgery confined to the right hemisphere. Severe left spatial neglect and constructional apraxia were also present. The patient was an achondroplasic dwarf whose previous medical and neurological history was otherwise unremarkable. Computed tomography of the brain showed a large right temporo-insulofrontoparietal lesion. Language and nonverbal cognitive functions were assessed after 2 and 6 months, and then four years later. A reportedly overall language disruption in the acute period evolved into Wernicke's aphasia and then into a mild form of conduction aphasia. The associated left spatial neglect eventually shrank to a minimum. The patient never had clinically detectable visual agnosia, but on specific tests of visual recognition and perception some impairment was found four years after onset. The left hemiparesis disappeared in time while the left hemianopia persisted. This case is a convincing example of an entirely righthanded person in whom both linguistic and visuospatial functions are represented in the right hemisphere.
OBJECTIVES: The natural course of aphasia in unselected, consecutive stroke patients is not well established. We investigated morbidity, mortality and recovery for different types of aphasia in consecutive unselected aphasic patients with acute stroke. Setting and subjects. In 119 aphasic patients, the type and degree of aphasia were assessed acutely and at 3, 6 and 18 months after stroke onset, using Reinvang's 'Grunntest for afasi' and Amsterdam-Nijmegen-Everyday-Language-Test. RESULTS: About one-third of patients with acute stroke had presented with aphasia. Mortality among the aphasic patients during the 18-month follow-up was twice that in non-aphasics (36 vs. 16%). Presence of atrial fibrillation was associated with poorer prognosis. At 18 months, 24% of the 119 aphasic patients had recovered completely, 43% still had significant aphasia, and 21% had died. The proportion with global aphasia decreased from almost 25% acutely to a few per cent after 18 months, that with Wernicke's aphasia from 25% to less than 10%, whereas conduction aphasia increased from 13 to 23% during follow-up. Among those with initial mild aphasia, 70% recovered completely. Great improvement was observed in patients with initial low degree of speech function. Younger patients recovered to a greater extent than older patients. CONCLUSION: The high long-term mortality among aphasics may be seen as an indirect sign of advanced cardiovascular disease. A combination of different and adjusted aphasia tests provided the possibility to assess almost all acute aphasic patients. Irrespective of type and degree of aphasia, great improvements were seen in almost all aphasic patients. Even patients with severe speech impairment have a considerable potential for recovery, particularly in the first 3 months after stroke.
The purpose of the study was to ascertain if Broca's aphasics have a comprehension defect which is dependent on syntactic relationships, to ascertain how this comprehension defect, if present, is different from that seen in Wernicke's and conduction aphasias. Twenty-six aphasic patients (nine Broca's eight conduction, nine Wernicke's) and eight controls were given a test which helped differentiate comprehension errors caused by syntactic incompetence from those caused by lexical incompetence. Wenicke's aphasics made significantly more lexical errors than each of the other groups. There were no significant differences between the lexical errors made by the other groups (Broca's, conduction, and control. There were no significant differences between Broca's and conduction aphasics, however both these groups made more syntactic errors than the controls.