1/13. Reorganization of speech production at the motor cortex and cerebellum following capsular infarction: a follow-up functional magnetic resonance imaging study.Based on clinical data, Geschwind assumed left hemisphere dominance of speech production to extend to the cortical representation of articulatory and phonatory functions at the motor cortex. This author suggested, furthermore, that the clinical observation of rapid recovery from articulatory impairments after damage to the left-sided corticobulbar tracts reflects compensatory activation of an alternative pathway involving the contralateral pre-central gyrus and its efferent projections. In order to test this hypothesis, functional magnetic resonance imaging (fMRI) was performed 4 and 35 days after stroke in a 38-year-old man who had experienced sudden speech deterioration ('dysarthric speech') concomitant with weakness of the right upper limb and the right side of the face. Computerized tomography demonstrated an ischaemic infarction within the left internal capsule. The patient fully recovered from dysarthria within 9 days. Activation of the right hemisphere analogues of Broca and Wernicke areas has been assumed to contribute to recovery from aphasia. As a further aspect of the reorganization of speech function, the present case study demonstrates for the first time by means of fMRI a selective 'shift' of the cortical representation of speech motor control to the right Rolandic cortex and the left cerebellum during restitution of articulation in a case of transient dysarthria following infarction of the left internal capsule.- - - - - - - - - - ranking = 1keywords = aphasia (Clic here for more details about this article) |
2/13. Progressive anarthria with secondary parkinsonism: a clinico-pathological case report.The pathological process and lesion topography in patients with the syndrome of progressive aphasia are heterogeneous and few necropsy examination cases have been investigated. This is a case report of a 53 year old right handed man with progressive anarthria and secondary Parkinsonism over a period of six years. Positron emission tomography (PET) showed a decreased cerebral blood flow and metabolism in the frontal cortex, which was more pronounced on the left. Neuropathology disclosed a spongiform vacuolation in layer II of the frontal cortex, mostly in the Broca area, and neuronal loss in the substantia nigra. This original case reinforces the view that there are different entities of the syndrome of progressive aphasia which can be identified on the basis of clinical, neuroimaging and anatomical data.- - - - - - - - - - ranking = 2keywords = aphasia (Clic here for more details about this article) |
3/13. Three variant forms of subcortical aphasia in Chinese stroke patients.Five right-handed patients with subcortical aphasia that involved the left hemisphere subcortical lesion sites were subjected to CT scans. Given their etiology, two cases were infarctions and the other three were hemorrhages. Two of the patients presented an involvement of the anterior limb of the internal capsule and of the basal ganglia and an anterior superior white-matter lesion extension. In both cases slow scanty dysarthric speech was noted; one had markedly impaired auditory comprehension, and the others were only partially impaired. The third patient presented an involvement of the posterior limb of the internal capsule and of the thalamus and a posterior paraventricular white-matter lesion extension. He had poor auditory comprehension, echolalia, and fluent speech. The last two patients presented an involvement of the internal capsule, the basal ganglia, and the thalamus and an anterior posterior paraventricular white-matter lesion extension. The latter two showed poor auditory comprehension with nonfluent and scanty spontaneous speech. The speech sounds were nonsensical monosyllabic words with a pattern similar to that of global aphasia. All patients had lasting right hemiplegia.- - - - - - - - - - ranking = 6keywords = aphasia (Clic here for more details about this article) |
4/13. Foix-Chavany-Marie-syndrome--neurological, neuropsychological, CT, MRI, and SPECT findings in a case progressive for more than 10 years.In a 66-year-old woman signs and symptoms of bilateral opercular syndrome (Foix-Chavany-Marie-syndrome) developed progressively over a period of more than 10 years. Facio-linguo-velopharyngeo-masticatory diplegia with automatic-voluntary dissociation was accompanied by motor aphasia and oral apraxia leading to a state of almost complete anarthria. Although it initially resembled the anterior biopercular syndrome there are also features indicating involvement of the posterior opercula. Although the aetiology remains obscure without pathological data, a bilateral focal brain atrophy is assumed. This is probably the first case documented by MRI and SPECT.- - - - - - - - - - ranking = 1keywords = aphasia (Clic here for more details about this article) |
5/13. Dysprosody in Broca's aphasia: a case study.A detailed acoustic analysis of timing, intensity, and fundamental frequency (F0) at different levels of linguistic structure was conducted on the speech output of a Broca's aphasic who was a native speaker of Thai. Timing was measured with respect to syllables, phrases, and sentences in connected speech. Intensity variation at the sentence level was measured in connected speech. F0 variation associated with the five Thai tones was measured in both isolated words and connected speech. Results indicated that timing was differentially impaired depending upon complexity of articulatory gesture and size of the linguistic structure. Timing, as well as intensity, was aberrant at the sentence level. In contrast, F0 contours of the five tones were spared at all levels of linguistic structure. Findings are interpreted to support the view that dysprosody in Broca's aphasia is more applicable to speech timing than to F0.- - - - - - - - - - ranking = 5keywords = aphasia (Clic here for more details about this article) |
6/13. Selective impairment of phonation: a case study.A 47-year-old right-handed man underwent craniotomy for clipping of an aneurism at the trifurcation of the left middle cerebral artery. Subsequently, he suffered a left hemisphere CVA after which his speech and language resembled that of Broca's aphasia with accompanying apraxia of speech. Medical, behavioral, and acoustical data amassed over a period of several months indicated numerous contraindications to traditional diagnoses of Broca's aphasia, apraxia of speech, and dysarthria. Ultimately, it was determined that the patient had a selective impairement of phonation or laryngeal apraxia. This was illustrated dramatically when he was taught to use an electrolarynx which allowed him to bypass his disrupted phonatory system. Speaking with the electrolarynx, the patient communicated normally. Any semblance of Broca's aphasia disappeared. Supralaryngeal articulation was normal; apraxia of speech behaviors were absent. This case report indicates that dissociation of oral and laryngeal gestures due to brain injury is possible. Mechanisms underlying such a dissociation for this case are reviewed. The possibility of discrete center lesions in the frontal motor association area causing different types of apraxia of speech is discussed.- - - - - - - - - - ranking = 3keywords = aphasia (Clic here for more details about this article) |
7/13. The labeling problem in aphasia: an illustrative case.Twenty-five "experts" on neurogenic motor speech disorders participated in a tutorial exercise. Each was given information on M, a patient who had communication difficulties as the result of stroke, and asked to complete a questionnaire about his problem. The information included a detailed case description, an audiotape of M's speech obtained at 4, 9, 13, and 17 days post-stroke, and test results from the Western Aphasia Battery, the Token Test, and a battery for apraxia of speech. The experts were in excellent agreement on M's primary problem, although it was called by seven different names. The experts were in poor agreement on his secondary problem(s), e.g., the presence and type of aphasia and dysarthria. The results suggest that labeling is difficult, even for "experts." Furthermore, the practicing clinician needs to be sensitive to the likelihood of more than one coexisting problem.- - - - - - - - - - ranking = 5keywords = aphasia (Clic here for more details about this article) |
8/13. Aphemia. Clinical-anatomic correlations.A syndrome of dysarthria following the appearance of small left frontal-lobe lesions has been recognized for many years but identified by numerous labels. Varied terminology has led to confusion in the literature and inadequate recognition of this syndrome as a distinctive clinical entity. We gathered clinical and anatomic (computed tomographic) data on four patients with this dysarthric syndrome and reviewed cases from the literature that contained sufficient clinical and anatomic data for comparison. These patients had a distinctive syndrome of dysarthria without aphasia, caused by small lesions of the motor system for articulation: pars opercularis, inferior prerolandic gyrus, or white matter deep to those regions. This syndrome should be distinguished from Broca's aphasia, broca's area aphasia, transcortical aphasia, and subcortical aphasia. Aphemia is not mild Broca's aphasia; it is severe dysarthria, at times in the setting of transient Broca's aphasia.- - - - - - - - - - ranking = 7keywords = aphasia (Clic here for more details about this article) |
9/13. Aphasia with nonhemorrhagic lesions in the basal ganglia and internal capsule.Atypical aphasia syndromes were associated with circumscribed nonhemorrhagic infarctions of the anterior limb of the internal capsule and of the striatum, in the dominant hemisphere. None of the several cases could be classified in terms of the classic cortical aphasia syndromes, nor did they correspond to the description of aphasia produced by hemorrhage in the thalamus or putamen. Control subjects without aphasia had lesions in the same structures of the nondominant hemisphere, or they had comparably circumscribed damage, which was located lateral or caudal to the previously indicated locus. The findings raise the question of participation of the dominant striatum, and of the connectional systems that course in the anterior limb of the internal capsule, in language processing.- - - - - - - - - - ranking = 4keywords = aphasia (Clic here for more details about this article) |
10/13. Opercular myoclonic-anarthric status epilepticus.We report 3 cases of opercular myoclonic status epilepticus (OMASE), characterized by fluctuating cortical dysarthria without true aphasia associated with epileptic myoclonus involving bilaterally the glossopharyngeal musculature. In this syndrome, the inferior rolandic area of either one or the other hemisphere is involved by an epileptogenic lesion of various etiology. Ictally, clonic expression was consistent with epilepsia partialis continua (EPC) and bilaterally and symmetrically involved palatal muscles (cases 1-3), tongue (cases 2 and 3), lips and chin (case 3), and inferior jaw (case 1) due to bilateral projections of the inferior corticonuclear pathways. Postictally, the main clinical sign was pseudobulbar palsy, consistent with Todd's palsy. In our cases, OMASE was either of vascular (cases 1 and 2) or tumoral origin (case 3). In adulthood, early recognition of OMASE, although nonspecific, may be important for early management of carotid occlusive disease because it usually indicates an acute opercular infarction.- - - - - - - - - - ranking = 1keywords = aphasia (Clic here for more details about this article) |
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