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PubMed1982

[Crossed aphasia in right-handed patients. II. Neuropsychological and neurolinguistic study of a case. Evolution over a 2 year period].

We present an unusual case of crossed aphasia in a doctor who is totally right handed, following an infarction which almost completely destroyed his right hemisphere. The observations--linguistic and extra linguistic--during a study over two years are presented. The aphasia evolved in three stages, taking semiological and evolutive aspects not commonly met with. In speech and writing there were: 1. an oral agrammatism and a written dyssyntaxia in the initial stage; 2. the evolution of a non-fluent speech typically agrammatic leading to a jargonaphasia; 3. a dissociation between oral and written language, characterised by phonemic paraphasias in speech and dyssyntaxia in writing. Comprehension was good except for a verbal class called "empty signs" of language, in which the lexic which refers to the notion of space and time has a primary role. On an extra linguistic level some of the usual signs of right hemisphere lesions were present indicating disturbances of a spatial type. The patient could no longer grasp the concept of numerical value and showed severe difficulties in relation to time. On a linguistic level, the discussion is first considered from a typological point of view; this allows to compare our patient's disorders with a Broca's then with a conduction aphasia, Secondly, the discussion is considered from a semiological point of view, taking into consideration the 10 selected cases in the literature and adding our own; a semiological formula of crossed aphasia is given: agrammatism and/or dyssyntaxia + phonemic paraphasia and/or dysorthographia. A suggestion concerning the role of each hemisphere in the language of our patient is proposed: the possible role played by a congenital deafness in the right ear (discovered in the patient at the age of 8) to explain this abnormal hemispherical functional specialisation is discussed. Original comprehension difficulties concerning the time-space lexic are replaced by a perspective of a cognitive type. We conclude that in our patient, there was a "breakdown" of time and space which comes close to the "indifferenciation" of spatial order and time which Piaget has described in children.

Aphasia↗

PubMed2002

Phonological agraphia after superior temporal gyrus infarction.

BACKGROUND: Phonological agraphia refers to a condition in which the ability to write nonwords to dictation is impaired, while writing words to dictation is preserved, as is oral repetition of the words and nonwords. This condition has been regarded as reflecting a disconnection within the phonological writing system, and previous neurolinguistic correlations suggested that the anterior-inferior supramarginal gyrus was a crucial link within the system. SETTING: A neurology department of a university hospital. PATIENT: A 51-year-old right-handed man presented with speech disturbances. On initial evaluation of his language, his deficit was consistent with that of conduction aphasia, which improved rapidly to an apparently normal level. A subsequent detailed examination of oral and written repetition of words and nonwords revealed a rather selective form of phonological agraphia. A magnetic resonance imaging scan of his brain showed a focal ischemic lesion at the left posterior superior temporal gyrus and at the underlying white matter. CONCLUSIONS: In contrast to most previously described patients, this patient showed a selective impairment of phonological agraphia in association with a focal infarction restricted to the left posterior superior temporal gyrus, suggesting that this region of the brain is an important node within a wider network of areas that subserve the phonological route for writing.

Agraphia↗

PubMed1996

Theoretical situation of brain white matter tracts evaluated by three-dimensional MRI.

An accurate knowledge of cerebral anatomy is important in order to evaluate the precise location of a cerebral lesion. Cortical structures are identified by knowledge of the adjacent gyri and sulci; however, white matter tracts are difficult to differentiate from one another due to the lack of clear anatomic landmarks. Therefore, even if MRI shows obvious white matter abnormalities, in some cases it is difficult accurately to localize the lesion. The purpose of this study is to evaluate the location of the main white matter tracts by using three-dimensional MR imaging. MRI study was performed by 1.5 Tesla (Signa: General Electric). Computer assisted analysis with Voxtool software (General Electric) was used to generate both surface brain and tomographic images. The exact anatomic basis of white matter signal abnormalities is important when analyzing patients with disconnective syndromes or neuropsychological deficits such as conduction aphasia, visuospatial deficit etc. This preliminary attempt at constructing a three-dimensional MRI white matter atlas of the brain may be helpful for evaluating the anatomico-clinical correlations in these patients, and also as teaching materials for the clinical (neurologic, neurosurgical), anatomic and radiographic disciplines.

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↗

PubMed1982

Difficulty in reaching objects and body parts: a sensory motor disconnexion syndrome.

A 19-year-old woman is described who, following an acute episode of eclampsia during pregnancy, displayed a complex neuropsychological syndrome. Along with a mild pattern of conduction aphasia, she showed a severe apraxia, total agraphia, marked constructional disturbances and was unable to reach targets outside and on her body and to perform accurate motor tasks under visual, tactile and proprioceptive control. These symptoms are discussed as the results of a disconnexion syndrome and related to the C.T. scan findings.

Adult↗

PubMed2001

Perceiving imitatible stimuli: consequences of isomorphism between input and output.

For more than a century, psychologists have been intrigued by the idea that mental representations of perceived human actions are closely connected with mental representations of performing those same actions. In this article, connections between input and output representations are considered in terms of the potential for imitation. A broad range of evidence suggests that, for imitatible stimuli, input and output representations are isomorphic to one another, allowing mutual influence between perception and motoric planning that is rapid, effortless, and possibly obligatory. Thus, the cognitive consequences of imitatibility may underlie such diverse phenomena as phoneme perception; imitation in neonates; echoic memory; stimulus-response compatibility; conduction aphasia; maintenance rehearsal; and a variety of developmental and social activities such as language acquisition, social learning, empathy, and monitoring one's own behavior.

Cognition↗

PubMed1987

Understanding: a function of short-term memory?

We describe our investigations of the sentence comprehension abilities of 2 patients with a severe impairment in their auditory verbal short-term memory (conduction aphasia). Both were capable of comprehending a range of sentences, even when adequate comprehension was dependent upon the processing of order-dependent syntactic information rather than the utilization of semantic knowledge. Thus they performed satisfactorily on tests using plausibly reversible subject and object constituents with either active or passive verb phrases or prepositional phrases. Both, however, were impaired on sentences which departed from normal conversational conventions in terms of their reference to the order of event occurrence, or to the subject and object of an array. They were also very poor at performing comparative judgements, even when these involved a simple intrinsic attribute such as colour. These findings are discussed in terms of the role of auditory verbal short-term memory in backing up and back-tracking over spoken information when conditions preclude the immediate understanding of auditory-verbal information.

Adult↗

PubMed1993

Sensory syndromes in parietal stroke.

We studied 20 patients with an acute parietal stroke with hemisensory disturbances but no visual field deficit and no or only slight motor weakness, without thalamic involvement on CT or MRI and found three main sensory syndromes. (1) The pseudothalamic sensory syndrome consists of a faciobrachiocrural impairment of elementary sensation (touch, pain, temperature, vibration). All patients have an inferior-anterior parietal stroke involving the parietal operculum, posterior insula, and, in all but one patient, underlying white matter. (2) The cortical sensory syndrome consists of an isolated loss of discriminative sensation (stereognosis, graphesthesia, position sense) involving one or two parts of the body. These patients show a superior-posterior parietal stroke. (3) The atypical sensory syndrome consists of a sensory loss involving all modalities of sensation in a partial distribution. Parietal lesions of different topography are responsible for this clinical picture, which probably represents a minor variant of the two previous sensory syndromes. Neuropsychological dysfunction was present in 17 patients. The only constant association was between conduction aphasia and right-sided pseudothalamic sensory deficit. We conclude that parietal stroke can cause different sensory syndromes depending on the topography of the underlying lesion. Sensory deficits can be monosymptomatic but never present as a "pure sensory stroke" involving face, arm, leg, and trunk together.

Adult↗

PubMed1997

Intraventricular, cystic, atypical meningioma.

A 37-year-old male presented with a very rare cystic meningioma in the trigone of the left lateral ventricle. Neurological examination revealed mild conduction aphasia and right hemisensory disturbance. Computed tomography and magnetic resonance imaging showed a solid, enhancing tumor in the left trigone which had multiple cystic components located anteriorly and superiorly. The tumor was totally resected via a parietal, transventricular approach. Histological examination revealed an atypical meningioma with cellular pleomorphism and prominent nucleoli. Both the solid component and the cyst wall consisted of tumor cells.

Adult↗

PubMed2003

Neuroanatomical correlates of the post-stroke aphasias studied with cerebral blood flow SPECT scanning.

BACKGROUND: Researchers are not in complete agreement over the extent to which specific language functions are subserved by certain brain areas. The purpose of this article was to determine neuroanatomical correlates of aphasia following cerebrovascular accident. MATERIAL/METHODS: The participants included 50 stroke patients with a single left-hemisphere lesion and residual mild to severe aphasia. Language, assessed by the Boston Diagnostic Aphasia Examination (BDAE), was affected to various degrees by a wide range of pathologies. Single-photon emission computed tomography (SPECT) images of the brain were acquired with 740 MBq (20 mCi) of Tc-99m-labeled ECD on a triple-headed gamma camera equipped with low-energy, high-resolution collimator. Correlation between reduced cerebral perfusion and the BDAE score was analyzed. RESULTS: The most prominent perfusion abnormalities in Broca's aphasia, as determined by the laterality index, were found in the frontal lobe, and to a lesser degree, the parietal lobe and striatum, whereas the most prominent deficits in Wernicke's aphasia were found in the left temporal and parietal areas. In global aphasia, SPECT images evidenced the most extensive damage throughout the perisylvian region of the left hemisphere. CONCLUSIONS: There is need for reinterpretation of the anatomical correlation of selected aphasic syndromes, especially classic Broca's and Wernicke's aphasias. The present study highlights the integrative role of some subcortical structures in language and speech functions. The results support the usefulness of regional cerebral blood flow SPECT imaging as a diagnostic aid in the post-stroke aphasias.

Adult↗

PubMed1987

Disordered auditory short-term memory in man and event-related potentials.

Four patients with conduction aphasia and impaired auditory but relatively preserved visual digit spans were tested in a task of short-term memory, a digit probe identification task, in both the visual and auditory modalities. Five age-matched normal subjects served as controls. Behavioural measures of response accuracy and reaction time and scalp derived event-related potentials were determined as a function of the number of items to be remembered. These measures were also recorded in a task requiring the detection of infrequent stimuli ('oddball' paradigm). The patients' performance and event-related potential wave forms for the 'oddball' task were no different from those of the controls. In the digit probe identification tasks the patients showed a reduction in amplitude of a positive component at a latency of approximately 450 ms (P450) of the event-related potential to correctly identified probes in the auditory modality. This component was within normal limits with visual testing. There was an inordinate increase in the patients' reaction time to auditory but not visual stimuli when the number of items to be remembered increased from one to three. Event-related potentials were also analysed as a function of speed of reaction time, position of the matching item in the stimulus presentation set and whether the probe was correctly identified as being in-set or out-of-set. Event-related potentials associated with fast reaction times in the auditory task when a single item was presented were no different between patients and controls, indicating that patients were capable of both performing normally and generating normal potentials on some trials. The data suggest that the deficit in auditory short-term memory in these patients occurs during stimulus classification.

Adult↗

PubMed1997

The importance of word-initial phonology: error patterns in prolonged naming efforts by aphasic patients.

Whether multiple conscious efforts at word search bring a subject closer to an elusive word and to eventual successful retrieval remains a subject of debate. Previous work with normal participants has shown that multiple attempts eventuating in correct retrieval are not usually associated with a systematic progression toward target word phonology in the intervening attempts. In this study we analyzed the naming errors produced by 30 aphasic patients who had received the Boston Naming Test. The analyses were designed to elucidate the characteristics of responses that led to eventual success. Our data showed that among aphasics, as with normal subjects, the presence of target-initial phonology in the subject's first response was the most important predictor of correct retrieval. Moreover, progression towards target phonology in the course of multiple attempts was unrelated to eventual correct retrieval.

Adult↗

PubMed1976

[A case of brain cysticerosis].

A 59-year-old man was admitted to our hospital with the history of epileptick attack of six years' duration. The seizure was associated with Jacksonian march starting in the right hand and then generalized. Todd's paresis of the right arm followed occasionally to the seizure. He was admitted to neurosurgical unit of other hospital in 1968 and 1971, but on each occasion no tumor or vascular abnormality was detected by extensive examiniations such as brain angiography, pneumoencephalography or brain scanning. He continued his hob as an engineer with anticonvulsant. He once lived in Manchuria in 1930s and had history of pulmonary tuberculosis. He was suffering from diabetes mellitus and chronic otitis media. Recentry he developed headache, forgetfulness, speech disturbance and right hemiparesis and was admitted to our department through psychiatric unit. On examination he was fully conscious but showed typical Gerstmann's syndrome and conduction aphasia. He also revealed bilateral choked disc, right hemiparesis, right hemihypesthesia and right homonymous hemianopsia. The cerebral angiograms and peneumoencephalogram suggested a left parietal cystic tumor. Brain scan with technetium 99m was negative. The spinal fluid was clear but showed slight pleocytosis (99/3/ml). Leucocyte count in the peripheral blood was 6600 per cubic meter with eosinophils of 3%. On craniotomy, small white patches were scattered at the subarachnoidal space suggesting of history of some meningitis. In the left parietooccipital region at Brodmann's area 19, a greyish yellow transparent cystic tumor was found in the subarachnoidal space which was confirmed to be one of the multilocular grape-like cystic tumors extending from area 19, gyrus angularis towards the arcuate fasciculus without continuity with the left lateral ventricle. Microscopic examination showed the racemosal type of cysticercus but no scolex was found. The fluid of the cysts was similar to the spinal fluid. He is totally symptome-free after five months' lapse from the operation except for sporadic spikes on the electroencephalogram. Although some neurosurgeons are against direct operation of the cerebral cysticercosis, we are sure it is possible to cure these patients suffering from chronic cysticercosis with tumor-like symptoms i.e. the tumor type of Stepien. But it is essential not to rupture the cysts during the operative procedure to avoid dissemination of worms which might lead to acute severe cerebral edema. Besides, echinococcus cysts harbouring many worms are often hardly differenciated macroscopically from the cysts of cysticercosis.

Brain Diseases↗

PubMed1983

Speech sound errors in patients with conduction and Broca's aphasia.

Speech sound errors exhibited by three conduction and three Broca's aphasic patients on naming and word-repetition tasks were subjected to phonemic and subphonemic analyses. In the conduction aphasic patients, errors occurred equally often on consonants and vowels in both the naming and word-repetition tasks, while in the Broca's aphasic patients errors occurred selectively on consonants. Transposition errors occurred almost as often as substitution errors in the conduction aphasic patients, while substitution errors constituted the majority of errors in the Broca's aphasic patients. The Broca's aphasic patients, as compared to the conduction aphasic patients, exhibited a markedly higher number of substitution errors occurring between phonemes separated by a single subphonemic feature on the naming task. On the basis of these findings, it was hypothesized that the differences in the error patterns of the two types of aphasia reflected differences in the underlying mechanisms of the impairment in each type.

Adult↗

PubMed1990

Aphasia in left-handers. Comparison of aphasia profiles and language recovery in non-right-handed and matched right-handed patients.

The present retrospective analysis reports two studies. In Study 1, clinical aspects of aphasia are compared in right-handed (RH) and non-right-handed (NRH) patients; in Study 2, recovery from aphasia is compared in RH and NRH aphasic patients with a minimum of 5 months of daily language rehabilitation. From a continuous series of 1200 brain-damaged subjects, 24 NRH patients with a vascular lesion documented by computerized tomography were selected. In 19 cases the lesion was in the left hemisphere and in 5 cases in the right hemisphere. For 14 NRH patients, a RH subject with similar lesion, matched for age, education, length of illness, etiology (ischemic vs. hemorrhagic), and, when possible, sex was found. Presence and type of aphasia were compared in the two patients of the same pair and were found similar except for Pair 14; the RH subject had global aphasia and the NRH had conduction-like aphasia. Fifteen NRH patients were rehabilitated and reexamined at least 5 months after the first examination. Recovery of the 12 patients with a left-hemisphere lesion was compared with recovery of a group of RH subjects and no significant differences were found. Recovery of the three patients with right-hemisphere lesions is described. It is concluded that differences in type of aphasia and recovery between RHs and NRHs have been overemphasized in the past and must be reconsidered.

Adult↗

PubMed1995

Coherence violations and propositional usage in the narratives of fluent aphasics.

Aphasic patients have been generally assumed to produce coherent narratives, despite their numerous surface structure deficits. The current study is designed to analyze three types of coherence violations (i.e., information gaps, repetitions of propositions, and irrelevant propositions) in the narratives of mildly impaired conduction, anomic, and Wernicke's aphasics. Results reveal that the three aphasic groups produce qualitatively different patterns of coherence violations. It is hypothesized that these coherence violations reflect adaptive strategies used by the aphasic patients to compensate for their underlying impairments. While the anomic and conduction aphasics appear to compensate for surface structure deficits, the Wernicke's aphasics seem to have an underlying coherence deficit.

Adult↗

PubMed1990

Repetition deficits in three aphasic syndromes.

This study examined the repetition errors of three aphasic subgroups during a repetition task. A total of 95 subjects, including 32 conduction, 38 Broca's, and 25 Wernicke's aphasics, repeated phrases and sentences from the Repeating Phrases Subtest of the Boston Diagnostic Aphasia Examination. Conduction aphasics exhibited a greater number of phonemic attempts, word revisions, and word and phrase repetitions. Broca's aphasics demonstrated more phonemic errors and omissions. Finally, Wernicke's aphasics showed more unrelated words and jargon.

Adult↗

PubMed1995

Levels of representation and units of access relevant to agrammatism.

The paper differentiates argument structure from other levels of representation and uses linguistic analysis of aphasic narrative production to support an enriched lexical entry for verbs that includes the d-structure representation of the configuration of the verb, its arguments, and any other lexically selected material. A single narrative production study and portions of two follow-up studies are presented. The argument structure distributions for two agrammatics (with varying degrees of fluency) and a nonagrammatic conduction aphasic with anomia are compared and contrasted with both matched controls and each other.

Anomia↗