Cases reported "Aphasia, Broca"

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1/196. A modality-specific mapping impairment: spoken versus written production.

    A 29 year-old dysphasic woman (AF) presented with superior ability in written over spoken sentences. In contrast, her comprehension showed the reverse trend. Cognitive neuropsychological investigations revealed that her double dissociation was more apparent than real. AF's superior auditory comprehension was attributed to suspected dyslexic factors impeding written comprehension. However, an account of a strong dissociation between her written and spoken production was less obvious. The evidence suggested AF suffered from a procedural mapping deficit which had a disproportionate effect on spoken production. AF's performance challenge current models of lexical access which consider syntactic knowledge to be amodal. An alternative account is considered within Caramazza's (1997) Independent Network model of lexical access. ( info)

2/196. Supplementary motor area aphasia: a case report.

    A 72-year-old right-handed woman developed aphasia after a left supplementary motor area (SMA) infarct. She had a right hemiparesis, more paretic on the leg, a tendency to look to her left, and loss of spontaneity. Neuropsychological deficits were mainly in the initiation of language production. She did not speak spontaneously, but responded and articulated well to questions. She named objects correctly when presented, and could repeat words, phrases, and sentences well. She had a difficulty in reading aloud, writing spontaneously and writing to dictation, but preserved the ability to copy written material. This is another rare case of SMA aphasia. ( info)

3/196. Representation of linguistic rules in the brain: evidence from training an aphasic patient to produce past tense verb morphology.

    We trained a patient with expressive aphasia and a deficit in phoneme-to-grapheme conversion to produce spoken English verbs with correct tense morphology. After training, he showed evidence of generalization to production of written regular, but not irregular, verbs in a sentence completion task. These data support dual-route, rule-based models within the brain for morphosyntactic operations. ( info)

4/196. Frontal-opercular aphasia.

    The standard nomenclature divides nonfluent aphasic syndromes with relatively spared comprehension into Broca's aphasia and transcortical motor aphasia. We report on a patient with a persistent nonfluent aphasia from a discrete, primarily cortical, frontal-opercular lesion who had impaired syntax but intact repetition and, therefore, did not conform to the traditional classification. Based on this patient's behavior and a review of other cases, we have divided the nonfluent aphasias with intact comprehension into five disorders. (1) Verbal akinesia-exhibiting diminished intention or drive to speak and associated with medial frontal lesions (supplementary motor area and cingulate gyrus) or with lesions damaging the efferent projections from these areas. (2) Disorders of syntax-telegraphic and agrammatic utterances that may be associated with dominant pars opercularis lesions. (3) Phonemic disintegration-a failure to correctly produce phonemes, which may be associated with injury to the opercular primary motor cortex or efferent projections from this area. (4) Defects of lexical access-patients who struggle to find words and are impaired at timed word-generation tasks. Defects of lexical access may be associated with lesions of the pars triangularis and adjacent prefrontal cortex. (5) Mixed defects. According to this model, the traditional patient with Broca's aphasia would exhibit disorders of syntax, phonemic disintegration, and defects of lexical access, whereas the traditional patient with transcortical motor aphasia would have verbal akinesia or defects of lexical access or both. Our patient had defects of lexical access and syntax, but only mild symptoms of phonemic disintegration, suggesting that his opercular primary motor cortex was relatively intact. Our patient's ability to repeat normally while his propositional speech remained telegraphic suggests that different neural mechanisms subserve these functions. ( info)

5/196. Functional magnetic resonance imaging to word generation task in a patient with Broca's aphasia.

    We describe the findings of functional magnetic resonance imaging (fMRI) in a patient with Broca's aphasia. The patient was a 45-year-old, right-handed woman who developed Broca's aphasia after infarction in the left frontal lobe. The first fMRI showed no signals in the left frontal lobe during verbal tasks, 2 weeks after the onset of infarction. Four weeks later, when the patient's symptom had improved, the second fMRI showed some increase in the fMRI signals in the left frontal lobe. Seven months later, she had completely recovered the ability to speak. The last fMRI then showed that the increment in signal activity in the left frontal lobe during verbal tasks had recovered to the level seen in normal subjects. There was a good correlation between the increase in task-related signals in Broca's area and the recovery of language function. Our findings show that fMRI has can be important in assessing cognitive functions in patients with Broca's aphasia. ( info)

6/196. Electromagnetic articulography treatment for an adult with Broca's aphasia and apraxia of speech.

    Electromagnetic articulography (EMA) was explored as a means of remediating [s]/[symbol in text] articulation deficits in the speech of an adult with Broca's aphasia and apraxia of speech. Over a 1-month period, the subject was provided with 2 different treatments in a counterbalanced procedure: (1) visually guided biofeedback concerning tongue-tip position and (2) a foil treatment in which a computer program delivered voicing-contrast stimuli for simple repetition. Kinematic and perceptual data suggest improvement resulting from visually guided biofeedback, both for nonspeech oral and, to a lesser extent, speech motor tasks. In contrast, the phonetic contrast treated in the foil condition showed only marginal improvement during the therapy session, with performance dropping back to baseline 10 weeks post-treatment. Although preliminary, the findings suggest that visual biofeedback concerning tongue-tip position can be used to treat nonspeech oral and (to a lesser extent) speech motor behavior in adults with Broca's aphasia and apraxia of speech. ( info)

7/196. Using fMRI to study recovery from acquired dysphasia.

    We have used functional magnetic resonance imaging (fMRI) to characterize brain activations associated with two distinct language tasks performed by a 28-year-old woman after partial recovery from dysphasia due to a left frontal hemispheric ischemic stroke. MRI showed that her ischemic lesion extended posteriorly from the left inferior frontal to the perisylvian cortex. fMRI scans of both language tasks revealed substantial differences in activation pattern relative to controls. The nature of this difference was task-specific. During performance of a verbal semantic decision task, the patient, in contrast to controls, activated a network of brain areas that excluded the inferior frontal gyrus (in either hemisphere). A second task involving rhyme judgment was designed to place a heavier cognitive load on language production processes and activated the left inferior frontal gyrus (Broca's area) strongly in normal controls. During this task, the most prominent frontal activation in the patient occurred in the right homologue of Broca's area. Subsequent analysis of this data by methods able to deal with responses of changing amplitude revealed additional, less sustained recruitment by the patient of cortex adjacent to the infarct in the region inferior to Broca's area during rhyming. These results suggest that in addition to changes in cognitive strategy, recovery from dysphasia could be mediated by both the preservation of neuronal networks in and around the infarct and the use of homologous regions in the contralateral hemisphere. ( info)

8/196. Chronological progression of a language deficit appearing to be postictally reversible in a patient with symptomatic localization-related epilepsy.

    A language deficit occurring interictally, with chronological progression, and postictally in a patient with symptomatic localization-related epilepsy, which began at 1.6 years of age, is reported. The patient was a 30-year-old right-handed man whose seizures seemed to originate from the left frontal lobe and to involve the left temporal lobe. The deficit in oral language consisted mainly of features of motor aphasia, including delayed initiation of speech with great effort, echolalic and palilalic tendencies, and word-finding difficulty, but he also showed features of sensory aphasia. Written language had agraphia observed in sensory aphasia, including well-formed letters, paraphasias, neologisms, and paragrammatism. Postictally, the language deficit appeared to be superficially reversible, and evolved from mutism through non-fluent jargon to the interictal level of language. Analysis of the patient's diaries from 10 to 26 years of age disclosed chronologically progressive deterioration of language with paragrammatism, showing an increase of grammatical errors, neologismus, literal and verbal paraphasias and misconstruction of sentences. The results suggest that localization-related epilepsy of presumably left frontal lobe origin causes not only a postictal language deficit but also a slowly progressive deficit of language function. ( info)

9/196. When does a deep dyslexic make a semantic error? The roles of age-of-acquisition, concreteness, and frequency.

    Semantic reading errors are the central and defining feature of deep dyslexia. This study compared the words the deep dyslexic patient LW read correctly with those she omitted and those to which she produced semantic errors in terms of their concreteness, age-of-acquisition, frequency, and length. Semantic errors were made to less concrete, later-acquired, and shorter words than were read correctly; there was no reliable effect of word frequency. More importantly, the actual semantic errors produced were later-acquired than the stimulus words, but they were not more concrete or reliably more frequent. These results implicate age-of-acquisition in the process that produces semantic errors. It is proposed that concreteness determines the specificity of the semantic system to activate a set of candidate responses and that age-of-acquisition biases the ease with which certain words can be selected from this set to be produced as reading responses. ( info)

10/196. Acute aphasia in multiple sclerosis.

    Acute aphasia is rare in multiple sclerosis. We describe 3 patients with multiple sclerosis who had acute exacerbations presenting as aphasias. One patient had a mixed transcortical aphasia, 1 had a transcortical motor aphasia, and 1 had a Broca aphasia. magnetic resonance imaging scans of the brain with contrast enhancement revealed new white matter lesions in the left hemisphere in all 3 patients. Two of the 3 patients had a good response to treatment with methylprednisolone sodium succinate. Arch Neurol. 2000;57:1207-1209 ( info)
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