1/922. A case of mixed transcortical aphasia with intact naming. Altholgh Lichtheim recognized that Wernicke's 'reflex arch' (primary auditory area, to Wernicke's area, to Broca's area, to primary motor area) was important for repetition, he recognized that other areas of the brain (for example, area of concepts or semantic area) must be important in comprehension and voluntary speech. He suggested that Wernicke's area (phonemic area) not only projected to Broca's area (as Wernicke suggested) but that it also projected to the area of concepts. A lesion of this latter pathway or in the area of concepts would produce a syndrome where repetition was intact but comprehension was impaired (e.g. transcortical sensory aphasia). Lichtheim also thought that the area of concepts projected directly to Broca's area and that voluntary speech was mediated by this pathway. Although Lichtheim's model could explain the mechanism underlying transcortical aphasia, his schema could not explain anomic aphasia. Unlike Lichtheim's schema, Kussmaul's schema suggested that the area of concepts projects back to Wernicke's area before projecting to Broca's area. With this schema, a patient with a hypothetical lesion which interrupted the pathway from the area of concepts to Wernicke's area (but did not interrupt the pathway from Wernicke's area to the area of concepts) should be anomic, with normal comprehension and repetition. In order for this latter schema to be plausible there should also be a lesion which interrupts the pathway from Wernicke's area to the area of concepts but does not interrupt the pathway which goes from the area of concepts to Wernicke's area. A patient with this hypothetical lesion should comprehend poorly; however, in spite of poor comprehension, naming and repetition should be intact. We report a patient who demonstrates poor comprehension with intact naming and repetition. This patient could also read aloud but could not comprehend written language. Not only could this patient name objects but he could demonstrate their use. These observations suggest that comprehension of written language is mediated by a different pathway than the recognition of visually presented objects. ( info) |
2/922. The recovery process of a bilingual aphasic. The recovery process during the first year poststroke in an English-Japanese bilingual aphasic is analyzed with special emphasis on the effect of language therapy. The patient initially manifested equally severe impairment in both English and Japanese involving all language modalities with moderate impairment of reading and auditory comprehension and severe impairment of oral production and writing. language therapy was conducted in English in a community where Japanese was the only language in the environment. In the course of language therapy, auditory and reading comprehension improved almost simultaneously in both English and Japanese. In contrast, oral language production and writing abilities improved markedly only for the treated language (English). The results are discussed in terms of their implication for the effect of language therapy on aphasia. ( info) |
3/922. Cross-modal priming and explicit memory in patients with verbal production deficits. Implicit memory is often thought to reflect an influence of past experience on perceptual processes, yet priming effects are found when the perceptual format of stimuli changes between study and test episodes. Such cross-modal priming effects have been hypothesized to depend upon stimulus recoding processes whereby a stimulus presented in one modality is converted to other perceptual formats. The present research examined recoding accounts of cross-modal priming by testing patients with verbal production deficits that presumably impair the conversion of visual words into auditory/phonological forms. The patients showed normal priming in a visual stem completion task following visual study (Experiment 1), but showed impairments following auditory study in both implicit (Experiment 2) and explicit (Experiment 3) stem completion. The results are consistent with the hypothesis that verbal production processes contribute to the recoding of visual stimuli and support cross-modal priming. The results also indicate that shared processes contribute to both explicit memory and cross-modal implicit memory. ( info) |
4/922. Conduction aphasia elicited by stimulation of the left posterior superior temporal gyrus. OBJECTIVE: Disruption of fascicular tracts that connect Wernicke's to Broca's areas is the classic mechanism of conduction aphasia. Later work has emphasised cortical mechanisms. methods: To determine the distribution of language on dominant cortex, electrical cortical stimulation was performed using implanted subdural electrodes during brain mapping before epilepsy surgery. RESULTS: A transient, isolated deficit in repetition was elicited with stimulation of the posterior portion of the dominant superior temporal gyrus. CONCLUSION: This finding suggests that cortical dysfunction, not just white matter disruption, can induce conduction aphasia. ( info) |
5/922. Downbeat nystagmus caused by thiamine deficiency: an unusual presentation of CNS localization of large cell anaplastic CD 30-positive non-Hodgkin's lymphoma. A 24-year-old woman with a large cell anaplastic CD 30-positive T-cell non-Hodgkin's lymphoma (NHL) developed downbeat nystagmus, anisocoria, and oscillopsia. Prior to overt cerebral invasion by NHL, she had a thiamine deficiency with very low thiamine concentrations in the CSF, probably caused by protracted vomiting and increased vitamin B1 consumption by intrathecal tumor cells. We believe that her neurologic symptoms were caused -- at least partly -- by thiamine deficiency, as she reacted well to thiamine supplementation at the beginning of treatment. ( info) |
6/922. Traumatic aphasia in children: a case study. Traumatic aphasia in children has been recognized as a distinct clinical pathology, differing from adult aphasia in symptomatology and course of recovery. The upper limit for complete recovery has been identified as age 10. However, there is a paucity of literature documenting recovery of children with traumatic aphasia. It is apparent that definitive statements of the upper age limit for complete recovery from traumatic aphasia in children cannot be made at this time. This article reviews the literature concerning traumatic aphasia and presents case information of a 10-year-old traumatic aphasic girl seen at the North texas State University Speech and hearing Center. The design, execution, and assessment of therapeutic interaction and the observed language abilities of the client are reported. ( info) |
7/922. A comparison of the codeswitching patterns of aphasic and neurologically normal bilingual speakers of English and Spanish. Conversational discourse samples were obtained from four aphasic and four neurologically normal Hispanic bilinguals in monolingual English, monolingual Spanish, and bilingual contexts to identify codeswitching patterns. Analysis of the samples based on the Matrix Language Frame (MLF) Model (Myers-Scotton, 1993a) revealed consistent matching of the language context by the aphasic and normal subjects. The aphasic subjects demonstrated a greater frequency of MLF constituents and codeswitching patterns not evident in the speech samples of the normal subjects. Results suggest an increased dependence on both languages for communication following neurological impairment. ( info) |
8/922. "White coat effect" induced by therapist's presence during speech therapy for stroke rehabilitation: a single case study. The excessive pressor response triggered in patients by an alerting reaction to a doctor's presence has been termed the "white coat effect." A 68-year-old man with verbal apraxia after multiple lacunar infarctions was referred to the hospital for speech rehabilitation. He experienced difficulty in talking with the speech therapist during therapy sessions but not when talking with his friends or family. Because the therapist's presence was stressful to the patient, it was considered that his anxiety might produce an excessive increase in blood pressure. blood pressure monitoring was performed during 2 separate days of speech therapies consisting of two sessions each. In one session, therapy was directed by the therapist; in the other, therapy was self-directed. The therapist-directed approach substantially increased both systolic and diastolic blood pressures, whereas the self-directed therapy slightly increased only systolic pressure. It was concluded that the excessive pressor response seen in this patient during therapist-directed speech therapy resulted from the white coat effect induced by the therapist's presence. ( info) |
9/922. Spared comprehension of emotional prosody in a patient with global aphasia. BACKGROUND: Several studies have demonstrated that patients with right hemisphere damage, when compared with left-hemisphere damaged controls, are impaired at comprehending emotional prosody. Critics of these studies, however, note that selection may have been biased because left-hemisphere-damaged subjects had good verbal comprehension. OBJECTIVE: To learn whether a subject with a large left hemisphere stroke and global aphasia could comprehend emotional prosody in spoken material. METHOD: The authors formally tested speech and language with the Western aphasia Battery and comprehension of emotional prosody and emotional facial expression with the florida affect Battery. RESULTS: The patient could not perform verbally mediated tests but demonstrated spared ability to match emotional prosody to emotional facial expressions under a variety of conditions. CONCLUSIONS: These observations further support the idea that verbal and emotional communication systems are independent and mediated by different hemispheres. ( info) |
10/922. 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. ( info) |