Case Of Aphasia Research Articles

Primer Progressive Aphasia with Psychiatric Symptoms

Primary Progressive Aphasia (PPA) is a rare neurodegenerative disease that is rarely observed with the relative preservation of mental functions such as memory, visuospatial functions, personal characteristics but that causes degeneration of speech function. Even though cognitive and behavioral functions are preserved during the starting stages, psychiatric symptoms may develop with the advancement of the disease. The objective of this study was to present a primary progressive aphasia case followed due to conversion disorder and depression for about 30 years and to discuss the confounding effects of the existing psychiatric symptoms at the diagnosis stage.

Clinical application of intraoperative MRI navigation in microsurgical resection of cerebral arteriovenous malformations located near the main functional areas

Objective To evaluate the efficacy and safety of intraoperative MRI navigation in the microsurgical treatment of arteriovenous malformations (AVM) located near the main functional areas of brain. Methods A total of 53 patients with AVM in the adjacent functional areas were treated by microsurgical operation with intraoperative MRI navigation and electrophysiological monitoring. Blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) and diffusion tensor imaging (DTI) examinations were performed before and during operation. We fused BOLD-fMRI and DTI images to form three-dimensional images containing lesions, important functional areas and pyramidal tract so as to study the relationship between them and their changes before and after operation. Results The diameter of malformations in 53 patients was 2-7 cm, on average of (3.41 ± 0.85) cm. There were 6 patients involved in sensory areas, 7 patients in motor areas, 10 patients in pyramidal tract, 14 patients in language areas, 2 patients in visual cortex, 9 patients in optic radiation, 2 patients in basal ganglia and 3 patients in brain stem. Gross total resection was achieved in 49 patients while full functionality was retained. The other 4 patients with intraoperative MRI navigation were found that malformations and functional areas were closely related, so the lesions were partially resected. There were 8 patients with new-onset postoperative neurological dysfunction, among whom one case was found bilateral visual field defects, 3 patients' muscle tone was lower than before, one case of facial paralysis, 2 cases of aphasia, one with decreased muscle tone and motor aphasia. Follow-up period varied from 3 to 60 months [median 19.37 (6.00, 30.00) months], and 2 cases died (one died of respiratory failure after one year, and the other was agnogenic). Glasgow Outcome Scale (GOS) score was 5 in 45 cases (84.91%), 4 in 3 cases (5.66%), 3 in 2 cases (3.77%), 2 in one case (1.89%) and one in 2 cases (3.77%). Conclusions With the application of intraoperative MRI navigation and electrophysiological monitoring, it may be appropriate to expand the surgical indications of AVM located near the main functional areas of brain. DOI: 10.3969/j.issn.1672-6731.2016.12.006

Architecture of Human Language from the Perspective of a Case of Childhood Aphasia — Landau–Kleffner Syndrome

This paper addresses Landau–Kleffner syndrome (LKS), a childhood aphasia, from the perspective of I-language and the critical period for first language acquisition. LKS involves a language disorder and behavioral disturbances resembling autistic spectrum disorders due to electroencephalographic abnormalities with continuous spike-and-waves during sleep over the temporal regions. Comparing LKS with other childhood syndromes, the architecture of language is explored through elucidating the linguistic mechanisms behind the language disorder in LKS on the basis of Hickok & Poeppel’s (2007) dual-stream model of speech processing. It is claimed that early onset LKS provides further support for the critical period for first language acquisition and modularity of mind (the faculty of language), and that verbal auditory input during the critical period is most crucial for language recovery and development in LKS. Considering that electroencephalographic abnormalities affect cognitive/motor functions, ameliorating neural dysfunction in the affected brain areas with proper application of trans-cranial direct current stimulation is recommended.

Comments on Broca's 1861 case of aphasia

Comments on Broca's 1861 case of aphasia

Common and divergent neural correlates of anomia in amnestic and logopenic presentations of Alzheimer's disease

The majority of logopenic variant primary progressive aphasia (lv-PPA) cases harbour Alzheimer pathology, suggesting that lv-PPA constitutes an atypical presentation of Alzheimer's disease (AD). However, even if caused by Alzheimer pathology, the clinical manifestations of lv-PPA differ from those observed in the typical or amnestic AD presentation: in lv-PPA, aphasia is the main feature while amnestic AD is characterised by impaired episodic memory. Anomia or impaired naming, however, is present in both AD presentations. Whether these presentations share anatomical and mechanistic processes of anomia has not been fully investigated. Accordingly, we studied naming performance and its relationship with regions of brain atrophy in 23 amnestic AD and 22 lv-PPA cases with presumed underlying Alzheimer pathology. Both AD groups displayed some degree of anomia and impaired word comprehension but these were particularly severe in lv-PPA and accompanied by a range of linguistic deficits, comprising phonological substitutions, superordinate semantic paraphasias and abnormal single-word repetition. Analysis of cortical thickness revealed that anomia was correlated with thinning in left superior temporal gyrus in both groups. In amnestic AD, however, anomia was also associated with thinning in right inferior temporal regions. Single-word comprehension (SWC), by contrast, was associated with cortical thinning involving bilateral fusiform gyri in both groups. These findings suggest that anomia in both amnestic AD and lv-PPA results from the involvement at multiple steps of word processing, in particular, semantic and lexical retrieval; in addition lv-PPA patients display a more marked involvement of phonological processing.

Toward a functional neuroanatomy of semantic aphasia: A history and ten new cases

Almost 70 years ago, Alexander Luria incorporated semantic aphasia among his aphasia classifications by demonstrating that deficits in linking the logical relationships of words in a sentence could co-occur with non-linguistic disorders of calculation, spatial gnosis and praxis deficits. In line with his comprehensive approach to the assessment of language and other cognitive functions, he argued that deficits in understanding semantically reversible sentences and prepositional phrases, for example, were in line with a single neuropsychological factor of impaired spatial analysis and synthesis, since understanding such grammatical relationships would also draw on their spatial relationships. Critically, Luria demonstrated the neural underpinnings of this syndrome with the critical implication of the cortex of the left temporal-parietal-occipital (TPO) junction. In this study, we report neuropsychological and lesion profiles of 10 new cases of semantic aphasia. Modern neuroimaging techniques provide support for the relevance of the left TPO area for semantic aphasia, but also extend Luria's neuroanatomical model by taking into account white matter pathways. Our findings suggest that tracts with parietal connectivity – the arcuate fasciculus (long and posterior segments), the inferior fronto-occipital fasciculus, the inferior longitudinal fasciculus, the superior longitudinal fasciculus II and III, and the corpus callosum – are implicated in the linguistic and non-linguistic deficits of patients with semantic aphasia.

Why Broca's Area Damage Does Not Result in Classical Broca's Aphasia

Why Broca's Area Damage Does Not Result in Classical Broca's Aphasia

左被殻出血後に記号素性錯語を呈した一例

左被殻出血後に記号素性錯語を呈した一例

Semantic and nonfluent aphasic variants, secondarily associated with amyotrophic lateral sclerosis, are predominant frontotemporal lobar degeneration phenotypes in TBK1 carriers

IntroductionTBK1 mutations represent a rare novel genetic cause of amyotrophic lateral sclerosis (ALS) without or with dementia. The full spectrum of TBK1 phenotypes has not been completely defined so far. MethodsWe describe the clinical and neuroimaging characteristics of loss-of-function mutation carriers initially presenting with frontotemporal lobar degeneration (FTLD) phenotypes. ResultsTwo carriers initially presented semantic variant of FTLD (svFTLD); two other developed nonfluent variant of FTLD (nfvFTLD) and corticobasal syndrome (CBS), associated with severe anterior temporal and opercular atrophy. All secondarily developed ALS. DiscussionThis study enlarges the phenotypic spectrum of TBK1 mutations, including svFTLD and nfvFTLD/CBS, not reported so far. Aphasic presentations seem to be more evocative of TBK1 genotype than behavioral variant of FTLD, and TBK1 should be analyzed in patients with isolated FTLD at onset, particularly in rare aphasic cases secondarily associated with ALS.

A Case of Non-fluent Conduction Aphasia

A Case of Non-fluent Conduction Aphasia

Three weeks spent in an early rehabilitation and post-intensive care unit significantly reduce disability of severely brain-injured patients discharged from hospital

Brain plasticity is a time dependant variable for neurological recovery after acute brain injury. To quantify functional benefit of a short stay in an early rehabilitation post-intensive care unit for severe brain injured patients. This retrospective cohort study took place in Early Rehabilitation Section (ERS) of Intensive Care Department of Grenoble University Hospital between 2011 and 2013. It focused on patients discharged from neurocritical care after acute brain injury. We have recorded Length of stay (LOS) and Functional Independence Measurement (FIM: total score = FIMc: cognitive and social score + FIMm: motor score), at admission and discharge from ERS. In ERS, rehabilitation took 2 hours per day, five days a week including speech language therapy, occupational therapy, physiotherapy and psychosocial support. One hundred and sixty-two patients were included, with median age 56, and ratio Female/Male 0.6. Seventy-nine had severe traumatic brain injury (TBI), thirty-one had subarachnoid haemorrhage, fifty-two had stroke. The median LOS was 28 days in intensive care, 22 days in ERS. The median FIM at admission in ERS: 22 points (FIMc 9, FIMm 13). The median FIM improvement at discharge from ERS: + 20 points (FIMc + 6 points, FIMm + 14). There was no statistical difference between traumatic and non-traumatic brain injured groups. Considering TBI patients: disorder of consciousness (DOC) was identified for 13, post-traumatic amnesia for 53. Considering vascular brain injured patients: 3 locked in syndrome, 16 akinetic mutisms, 32 severe dysexecutive disorder, and 17 were severe aphasia cases. If necessary, neurosurgical treatment was planned during ERS stay to accelerate functional recovery (cranioplasty, cerebrospinal fluid shunt). Amantadine was administered in case of DOC. Any medication which could reduce cognitive ability was avoided. Rehabilitation goal was focused on efficient communication, reduction of anxiety and sleep disorder, ability to swallow, wheelchair mobility and removal of all catheters. Three weeks of early specialized rehabilitation promotes functional recovery for severe acute brain injured patients immediately after intensive care discharge. Patients are thereafter discharged to out-hospital rehabilitation centers with higher safety and lower dependency.

18F-FDG PET Improves Diagnosis in Patients with Focal-Onset Dementias.

Alzheimer disease is the cause of up to one-third of cases of primary progressive aphasia or corticobasal syndrome. The primary objective of this study was to determine the accuracy of 18F-FDG PET metabolic imaging for the detection of Alzheimer disease in patients with primary progressive aphasia or corticobasal syndrome. A cohort of patients (n=94), including those with an expert clinical diagnosis of logopenic (n=19), nonfluent (n=16), or semantic (n=13) variants of primary progressive aphasia, corticobasal syndrome (n=14), or Alzheimer disease (n=24), underwent 18F-FDG metabolic and 11C-labeled Pittsburgh compound B (11C-PiB) amyloid PET brain imaging. 18F-FDG PET scans interpreted with Neurostat and 3D-SSP displays were classified as revealing Alzheimer disease or "other" by interpreters who were unaware of the clinical assessments and 11C-PiB PET results. 11C-PiB PET imaging was considered to be the diagnostic reference standard, with a threshold standardized uptake value ratio of 1.5 being indicative of Alzheimer disease pathology. To address possible bias from subgroup selection for the Alzheimer disease binary classifier, we calculated both conventional and balanced accuracies. Diagnoses of Alzheimer disease based on 18F-FDG PET resulted in 84% accuracy (both conventional and balanced). In comparison, diagnoses based on clinical assessments resulted in 65% conventional accuracy and 67% balanced accuracy. Brain 18F-FDG PET scans interpreted with Neurostat and 3D-SSP displays accurately detected Alzheimer disease in patients with primary progressive aphasia or corticobasal syndrome as focal-onset dementias. In such diagnostically challenging cohorts, (18)F-FDG PET imaging can provide more accurate diagnoses, enabling more appropriate therapy.

The standardization of a Uighur Aphasia battery

Objective To study the reliability and validity of an aphasia battery of Uighur (ABU). Methods The Chinese Aphasia Battery (ABC) was translated into Uighur. Appropriate adaptation was made according to the features of Uyghur language, but the overall structure was unchanged. Three rounds of comments and revisions were conducted by experts and the ABU was back-translated into Chinese after language adjustment and pretesting. The ABU was then applied to evaluating 104 cases of stroke aphasia among Uighur speakers, among which 30 cases were retested one week later. The construct validity, internal reliability, retest reliability and split-half reliability of the scale were tested using factor analysis and Spearman rank correlation analysis. Results The discrepancy between the original and back-translated ABC was less than 10%. The Kaiser-Meyer-Olkin value was 0.917 and the p value of the Bartlett's test for sphericity was ≤0.005. Three common factors were extracted using principal component analysis with a varimax orthogonal rotation: a writing factor; and a listening comprehension factor. Together they explained a total of 81% of the variance. The Cronbach's α of the components were 0.969 for oral expression, 0.922 for listening comprehension, 0.966 for reading and 0.924 for writing, giving a total α coefficient of 0.978. The test-retest correlation coefficients of 22 items were greater than 0.8, with only another two below 0.7. The split-half reliability of the scale was 0.906. Conclusions The aphasia battery in Uighur has good validity and reliability, and can quantitatively reflect the functional status and language changes among Uighur's with stroke aphasia. It may also be suitable for application in the clinical rehabilitation of other sorts of Uighur-speaking aphasics. Key words: Uyghur language; Aphasia test; Reliability; Validity

Functional Neuronavigation-Guided Transparieto-Occipital Cortical Resection of Meningiomas in Trigone of Lateral Ventricle

This study investigated whether functional neuronavigation can be used to remove lesions in the lateral ventricle while preserving patients' neurologic functionality. A total of 60 patients with lateral ventricular meningiomas were divided into study and control groups (n = 30 each). Diffusion tensor and blood oxygenation level-dependent functional magnetic resonance imaging were used for fiber tracking and eloquent cortex localization, respectively, in the study group. The surgical approach was based on coregistered data sets from 3-D lesion and brain structure reconstructions. Patients in the control group underwent anatomic neuronavigation-guided surgery. The patients' demographics, degree of resection, visual field, language score, movement, preoperative and postoperative Karnofsky Performance Status (KPS) scores, and surgical complications were recorded. Tumors were completely removed in both groups. Patients in the study group had a higher rate of visual field preservation than controls (P = 0.01). The two groups had similar motor and language functions after surgery, except that fewer cases of transient aphasia were observed in the former (P < 0.05). KPS scores for the study and control groups were 80 (70-80) and 70 (60-70), respectively (P < 0.01), at 2 weeks and 90 (80-100) and 85 (70-90), respectively (P = 0.022), at 3 months after surgery. Functional neuronavigation preserved neurologic functionality and was especially beneficial for protecting optical functionality and for the rapid recovery of patients.

Eficacia del tratamiento para la afasia de Wernicke en pacientes con sintomatología grave

IntroductionAphasia is a language disorder which causes, in most cases, an inability to communicate, which implies a handicap not only for the patient but also for the family environment. Patient rehabilitation is considered vital to redress this communicative dysfunction. Conventional speech therapy is useful, but for cases of aphasia with severe disturbances it is too slow. To solve this problem, in the field of the Wernicke's aphasia was developed the Treatment for the Wernicke's aphasia (TWA), which it is showed effective in a specific set of candidates. ObjectiveTo assess TWA in Wernicke's aphasia patients who had severe symptoms, although they were not candidates for the original conventional treatment. Method12 sessions of TWA were performed with a Wernicke's patient, and pre- and post-treatment results of the patient were compared with a group of Wernicke's patients (one with the same etiology and location) and with a group of transcortical sensory aphasia's patients (Wernicke aphasia typeii). ResultsThe results show, in almost all the analyzed verbal areas, a greater improvement in the patient who completed the TWA compared to patients who followed conventional speech therapy. ConclusionsFrom the results obtained in this study it can be concluded that the TWA is an useful therapeutic treatment for all classes of patients with Wernicke's aphasia, and not just for the candidates in initial rehabilitation.

Editorial: the ischemic penumbra: still the target for stroke therapies?

Editorial: the ischemic penumbra: still the target for stroke therapies?

Dominant Frontotemporal Dementia Mutations in 140 Cases of Primary Progressive Aphasia and Speech Apraxia

Background: Mutations in three genes [chromosome 9 open-reading-frame 72 (C9ORF72); microtubule-associated protein tau (MAPT) and progranulin (GRN)] account for the vast majority of familial, and a proportion of sporadic, frontotemporal dementia (FTD) cases. Progressive apraxia of speech (PAOS) is a type of FTD characterized by speech production deficits without a known cause. Methods: We therefore assessed for genetic mutations in C9ORF72, MAPT and GRN in 40 prospectively recruited PAOS patients. For comparison, we also assessed these mutations in 100 patients with primary progressive aphasia (PPA), including logopenic PPA (n = 54), nonfluent/agrammatic PPA (n = 17), semantic PPA (n = 16), and unclassifiable PPA (n = 13). Results: The mean age at onset of PAOS patients was 66.7 years (± 9.3); 50% were women. Ten patients (25%) had ≥1 first-degree relative with a neurodegenerative disease. No mutations were found in any PAOS patient. In comparison, 36% of the PPA patients had a family history and 5 (5%) had a genetic mutation detected: MAPT (n = 0), GRN (n = 3) and C9ORF72 (n = 2). Conclusions: Although limited by an overrepresentation of logopenic PPA, which frequently predicts Alzheimer's disease pathology, this study suggests that mutations in the three genes most commonly associated with FTD are not associated with PAOS and are not commonly associated with PPA.

Fourteen cases of transient aphasia induced by head-up tilt test

Objective To explore the clinical characteristics and the possible pathogenesis for transient aphasia induced by head-up tilt test(HUTT). Methods The data of 4 401 cases(aged from 2 to 79 years) were reviewed retrospectively with unexplained syncope, pre-syncope, or dizziness who had visited syncope specialists at out-patient department or had been hospitalized in the Second Xiangya Hospital of Central South University, and they underwent HUTT from Sep.2000 to Apr.2014.The clinical characteristics were summarized and the possible pathogenesis for transient aphasia was analyzed. Results (1)The total incidence of aphasia was 3.18‰(14/4 401 cases). The incidence in adult(≥18 years old) was significantly higher than that in children( 0.05]. According to the hemodynamic changes, the incidences in vasodepressor, the mixed type, cardioinhibition and the negative response were 6.05‰(10/1 654 cases), 4.18‰(2/479 cases), 0(0/36 cases) and 0.9‰(2/2 232 cases) respectively, and the differences among the 4 groups were significant(χ2=8.22, P<0.05); the difference existed between the vasodepressor and the negative response(χ2=8.18, P<0.01). The total incidence of the positive response patients was 5.53‰(12/2 169 cases), and the difference was notable compared with the negative response patients (χ2=6.07, P<0.05). (2)The onset time and the duration time of transient aphasia: the onset time was from 4 to 17 minutes during baseline head-up tilt test, mean (11.3±6.7) minutes, or 2-10 minutes during sublingual nitroglycerin-provocated head-up tilt test, mean (5.2±2.7) minutes.Aphasia duration was from 3 minutes to 4 hours, and the median time was 20 minutes. Conclusions There is a risk of provoking transient aphasia during HUTT, which reminds that the performer should alert possible occurrence of this complication during the test, especially when the patient has a positive response, or is an adult. Key words: Head-up tilt test; Transient aphasia; Clinical characteristic

Relationship of Post-Stroke Aphasic Types with Sex, Age and Stroke Types

Aim: To explore what is the relationship of the types of post-stroke aphasia with sex, age and stroke types. Methods: Retrospective analysis was administrated on data of 421 patients with acute stroke. Western battery aphasia was used to measure aphasiac type and aphasia quotient (AQ) score. The patients were divided into three age groups: young, middle-aged and elderly. The stroke types were classified into cerebral infraction (CI) and intracerebral hemorrhage (ICH). Results: All subjects were right-handed, which males and females accounted for 69.60% and 30.40%, respectively. There were 116 cases of Broca’s aphasia (85 males), 35 cases of Wernicke’s aphasia (20 males), 15 cases of conductive aphasia (10 males), 63 cases of transcortical motor aphasia (50 males), 11 cases of transcortical sensory aphasia (8 males), 27 cases of transcortical combined aphasia (13 males), 73 cases of anomic aphasia (47 males) and 81 cases of global aphasia (60 males). Male patients (69.60%) have a significantly higher morbidity of aphasia than that of females (30.40%) after stroke (χ2 = 11.57, P = 0.003), especially those under 65 years old (73.38%). For people 65 years and older, the morbidity of female (42.97%) tends to increase with age. Sex has no significant influence on the types of aphasia (χ2 = 13.84, P = 0.054). Broca’s aphasia is the most common type inboth male and female (29.01%, 24.22%, respectively). The distribution of aphasic types has no obvious difference among three age groups (χ2 = 14.94, P= 0.382). Aphasia induced by CI (306 cases) is more common than that by ICH (115 cases), but there was no difference in distribution of types of aphasia (χ2 = 13.23, P = 0.067). Conclusions: Male patients have a significantly higher level of morbidity of aphasia than females after stroke and a lower average age of onset than females. Broca’s aphasia is the most common one in both male and female. Broca’s aphasia, global and anomic aphasia are the most common aphasic types in both CI and ICH patients, except the female with ICH.

Treatment-Induced Neuroplasticity Following Intensive Speech Therapy and a Home Practice Program in Fifteen Cases of Chronic Aphasia

Treatment-Induced Neuroplasticity Following Intensive Speech Therapy and a Home Practice Program in Fifteen Cases of Chronic Aphasia