Cases reported "Aphasia"

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1/185. 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.
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2/185. stroke-associated stuttering.

    OBJECTIVE: To present patients with stuttering speech in association with stroke. DESIGN: Case series with follow-up for 5 years, or until the stuttering resolved. SETTING: University and community hospital neurology wards, and ambulatory neurology clinics. patients: Four patients who developed stuttering speech in association with an acute ischemic stroke. A 68-year-old man acutely developed stuttering with a large left middle cerebral artery distribution stroke. A 59-year-old man who had stuttered as a child began to stutter 2 months after a left temporal lobe infarction, as nonfluent aphasia was improving. Another childhood stutterer, a 59-year-old originally left-handed man developed severe but transient stuttering with a right parietal infarction. A 55-year-old man with a left occipital infarction had a right hemianopia and an acquired stutter, for which he was anosognosic. CONCLUSION: The clinical presentation of stroke-associated stuttering is variable, as are the locations of the implicated infarctions.
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keywords = cerebral
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3/185. functional neuroimaging of speech perception in six normal and two aphasic subjects.

    This positron emission tomography study used a correlational design to investigate neural activity during speech perception in six normal subjects and two aphasic patients. The normal subjects listened either to speech or to signal-correlated noise equivalents; the latter were nonspeech stimuli, similar to speech in complexity but not perceived as speechlike. Regions common to the auditory processing of both types of stimuli were dissociated from those specific to spoken words. Increasing rates of presentation of both speech and nonspeech correlated with cerebral activity in bilateral transverse gyri and adjacent superior temporal cortex. Correlations specific to speech stimuli were located more anteriorly in both superior temporal sulci. The only asymmetry in normal subjects was a left lateralized response to speech in the posterior superior temporal sulcus, corresponding closely to structural asymmetry on the subjects' magnetic resonance images. Two patients, who had left temporal infarction but performed well on single word comprehension tasks, were also scanned while listening to speech. These cases showed right superior temporal activity correlating with increasing rates of hearing speech, but no significant left temporal activation. These findings together suggest that the dorsolateral temporal cortex of both hemispheres can be involved in prelexical processing of speech.
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keywords = cerebral
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4/185. Making sense out of jargon: a neurolinguistic and computational account of jargon aphasia.

    OBJECTIVE: To identify the cognitive and neuroanatomic bases of neologistic jargon aphasia with spared comprehension and production of written words. methods: Detailed analysis of performance across experiments of naming, reading, writing, repetition, and word/picture matching by a 68-year-old woman (J.B.N.) served to identify which cognitive mechanisms underlying naming and word comprehension were impaired. J.B.N.'s impairments were then simulated by selectively "lesioning" a computer model of word production that has semantic, word form, and subword phonologic levels of representation (described by Dell in 1986). RESULTS: In comprehension experiments, J.B.N. made far more errors with spoken word input than with written word or picture input (chi-square = 40-59; df = 1; p < 0.0001) despite intact auditory discrimination. In naming experiments (with picture, definition, or tactile input), J.B.N. made far more errors in spoken output relative to written output (chi-square = 14-56; df = 1; p < 0.0001). These selective impairments of spoken word processing were simulated by reducing connection strength between word-level and subword-level phonologic units but maintaining full connection strength between word-level and semantic units in Dell's model. The simulation yielded a distribution of error types that was nearly identical to that of J.B.N., and her CT and MRI scans showed a small subarachnoid hemorrhage in the left sylvian fissure without infarct. Cerebral angiogram showed focal vasospasm in sylvian branches of the left middle cerebral artery. CONCLUSION: Focal left perisylvian dysfunction can result in a highly selective "disconnection" between word-level and subword-level phonologic representations manifest as neologistic jargon aphasia with intact understanding and production of written words.
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keywords = cerebral
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5/185. Forced hyperphasia and environmental dependency syndrome.

    A distinctive, language related fragment of the environmental dependency syndrome is described: compulsive, involuntary, environmentally dependent speaking. Because this syndrome represents the observe of aphasia, it is named forced hyperphasia. An 84 year old woman with acute left frontal infarction was admitted to hospital with gait disturbance, forced grasp reflex, and striking imitation behaviour. After 2 weeks her imitation behaviour disappeared, but an equally striking new behaviour emerged. In the presence of others she would call out the names of objects in the room, and also call out the actions and gestures of people in the room, even though she was not asked to do so, and even though she was asked to stop. For example, if the doctor scratched his nose, she said, "The doctor is scratching his nose." Brain CT, MRI, and SPECT showed cerebral atrophy and a left superior frontal subcortical infarct. It is suggested that "forced hyperphasia" is a clinical fragment of the environmental dependency syndrome and that her compulsive, impulsive, involuntary release of spoken language resulted from the release of frontal inhibition of the complex reflex linking environmental cues to the set of motor, limbic, spatial, and linguistic associations underlying spoken language.
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keywords = cerebral
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6/185. Rapidly progressive aphasia and motor neuron disease: a clinical, radiological, and pathological study of an autopsy case with circumscribed lobar atrophy.

    This report concerns an autopsy case of rapidly progressive aphasia and motor neuron disease. The patient was a Japanese woman who was 75 years old at the time of death. The family history did not reveal hereditary burden. She developed language disturbances and difficulty in swallowing at age 74. Neurological examination 1 month after the disease onset revealed motor aphasia without dementia and bulbar sign, followed by muscle weakness of the four extremities. Neuroradiological examination revealed progressive atrophy of the anterior part of the left temporal lobe. She died of respiratory difficulty 10 months after the disease onset. Macroscopically, neuropathological examination showed circumscribed atrophy of the left perisylvian region and, histologically, neuronal loss in the cerebral cortex, including the primary motor area, substantia nigra, brain stem motor nuclei, and anterior horns of the spinal cord, in addition to obvious degeneration of the pyramidal tracts and presence of Bunina bodies. ubiquitin-immunoreactive neuronal inclusions were present in the hippocampal dentate granular cells and frontotemporal cortical layer II neurons. Based on these clinicopathological findings and a review of the literature, we concluded that our case is the first reported case of amyotrophic lateral sclerosis with dementia that clinically showed rapidly progressive aphasia.
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keywords = cerebral
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7/185. Moyamoya syndrome with protein s deficiency.

    moyamoya disease is a cerebrovascular disease with progressive occlusion of both internal carotid arteries and of their branches and formation of a new vascular network at the base of the brain. Because of the angiographic appearance, it is named as moyamoya. The clinical features are cerebral ischaemia, recurrent transient ischaemic attacks, sensorimotor paralysis, convulsions and migraine-like headaches. A 10-year-old child who acutely developed hemiparesis, weakness and aphasia was found to have moyamoya disease and heterozygous protein S deficiency. This case shows us that during the thromboembolic events the coexistence of protein s deficiency and moyamoya should be investigated.
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keywords = cerebral
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8/185. Ictal increased writing preceded by dysphasic seizures.

    Ictal increased writing has never been concretely demonstrated to be an epileptic symptom. We reported the evolution of seizures, from the beginning of reading-writing dysphasia through increased writing to secondary generalization, in a schoolchild with benign partial seizures. The lateralizing value of inter- or non-ictal hypergraphia has been stressed for the right hemisphere, while ictal increased writing most likely originated from the language area in the dominant (left) cerebral hemisphere in our patient.
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keywords = cerebral
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9/185. Anomalous cerebral language organization: acquired crossed aphasia in a dextral child.

    Following a dramatic change of its reported incidence, it was only recently recognized that acquired crossed aphasia in dextral children represents a highly exceptional phenomenon. We describe in a three epoch time-frame model the aphasic and neurocognitive manifestations of an additional case and focus briefly on its anatomoclinical configurations. In our patient, a right parietal cortico-subcortical hemorrhagic lesion caused an initially severe aphasia. After remission of the global aphasic symptoms in the acute phase, an adynamic output disorder with relatively severe auditory-verbal comprehension disturbances developed. In addition to the adynamia of self-generated speech, formal language investigations performed 3 weeks postonset, revealed agrammatism, hypertonic dysarthria, and dysprosodia. A substantial improvement of the aphasic disorder was objectified 83 days postonset. Neuropsychological investigations disclosed both dominant and nondominant hemisphere dysfunctions. Reassessment of neurocognitive functions after a 10-year period evidenced discrete residual anomia, confined to visual confrontational naming and a discrete visuo-perceptual syndrome. Given the posterior localization of the lesion, the syndrome shift from global to predominantly adynamic aphasia represents a finding beyond the plausible anatomoclinical expectations holding in general for the uncrossed, classic types of childhood and adult aphasia. As the first representative of crossed aphasia in dextral children with an anomalous lesion-aphasia profile, our case provides evidence to enrich the discussion on lateralization and intrahemispherical organization of language functions in both childhood and adult aphasia.
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ranking = 4
keywords = cerebral
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10/185. stroke in hemoglobin (SD) sickle cell disease with moyamoya: successful hydroxyurea treatment after cerebrovascular bypass surgery.

    An 11-year-old boy with hemoglobin sickle disease (HbSD), bilateral stenosis of the intracranial carotid arteries, and moyamoya syndrome had recurrent ischemic strokes with aphasia and right hemiparesis. His parents (jehovah's witnesses) refused blood transfusions. After bilateral extracranial-intracranial (EC-IC) bypass surgery, hydroxyurea treatment increased hemoglobin F (HbF) levels to more than 30%. During a follow-up of 28 months, flow velocities in the basal cerebral arteries remained stable, neurologic sequelae regressed, and ischemic events did not recur. This is the first report of successful hydroxyurea treatment after bypass surgery for intracranial cerebral artery obstruction with moyamoya syndrome in sickle cell disease. The patient's religious background contributed to an ethically challenging therapeutic task. (blood. 2001;97:2165-2167)
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keywords = cerebral
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