Cases reported "Aphasia"

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1/53. 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.
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2/53. Acquired aphasia in acute disseminated encephalomyelitis.

    A 12-year-old boy developed a convulsion, hemiparesis, and acquired aphasia with paroxysmal electroencephalogram (EEG) abnormalities consisting of repetitive spikes and waves in the left centro-parietal region. T2-weighted magnetic resonance imaging disclosed high intensity lesions in the left pre-Sylvian and right frontal areas. He was diagnosed as having acute disseminated encephalomyelitis, and thus the oral administration of phenytoin and steroid pulse therapy were begun. With these treatments, his hemiparesis disappeared and the aphasia also improved gradually. magnetic resonance imaging examination revealed the disappearance of the previously noted abnormalities, and the EEG abnormalities disappeared as well. This patient is a rare case of acute disseminated encephalomyelitis presenting an acquired aphasia. A focal lesion of acute disseminated encephalomyelitis may be responsible for the acquired aphasia. The distinction from landau-kleffner syndrome is also discussed.
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keywords = wave
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3/53. Visual paralexias in a Spanish-speaking patient with acquired dyslexia: a consequence of visual and semantic impairments?

    We report the case of a Spanish patient SC who misread 55 per cent of the single words shown to her. SC's reading accuracy was affected by word imageability and frequency. Nonword reading was very poor. The majority of SC's errors to real-word targets bore a close visual similarity to the items that elicited them, but there was no indication of an effect of serial position on the probability that a letter from a target word would be incorporated into the error made to that word. SC made some visual errors in object naming and also showed evidence of a general semantic impairment. We consider the similarity between SC and patient AB reported by Lambon Ralph and Ellis (1997), and suggest that the very high levels of visual errors shown by these two patients may reflect a combination of visual and semantic impairments.
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4/53. Childhood epilepsy with neuropsychological regression and continuous spike waves during sleep: epilepsy surgery in a young adult.

    We describe the case of a man with a history of complex partial seizures and severe language, cognitive and behavioural regression during early childhood (3.5 years), who underwent epilepsy surgery at the age of 25 years. His early epilepsy had clinical and electroencephalogram features of the syndromes of epilepsy with continuous spike waves during sleep and acquired epileptic aphasia (landau-kleffner syndrome), which we considered initially to be of idiopathic origin. seizures recurred at 19 years and presurgical investigations at 25 years showed a lateral frontal epileptic focus with spread to Broca's area and the frontal orbital regions. Histopathology revealed a focal cortical dysplasia, not visible on magnetic resonance imaging. The prolonged but reversible early regression and the residual neuropsychological disorders during adulthood were probably the result of an active left frontal epilepsy, which interfered with language and behaviour during development. Our findings raise the question of the role of focal cortical dysplasia as an aetiology in the syndromes of epilepsy with continuous spike waves during sleep and acquired epileptic aphasia.
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5/53. Effects of high-dose intravenous corticosteroid therapy in landau-kleffner syndrome.

    Two children with landau-kleffner syndrome were successfully treated with antiepileptic drugs and a high-dose intravenous corticosteroid. A combination of valproate and a benzodiazepine (clonazepam or diazepam) ameliorated epileptic seizures and electroencephalographic spikes and waves, but speech disturbances persisted. Both patients were treated with an intravenous infusion of high-dose methylprednisolone sodium succinate (20 mg/kg daily) for 3 consecutive days. This infusion was repeated three times with a 4-day interval between treatments, which resulted in a rapid improvement in speech ability. After intravenous therapy, prednisolone was given orally (2 mg/kg daily for 1 month, then gradually withdrawn), which maintained the clinical improvement in speech.
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6/53. Absence of amusia and preserved naming of musical instruments in an aphasic composer.

    M.M., a right-handed, 74 year old professional musician and composer, presented with a progressive aphasia with a severe anomia. His musical competence was apparently totally preserved, and he continued his activity as a composer. There was a striking discrepancy between his impaired naming of nonmusical stimuli and his normal naming of musical instruments' sounds. We suggest that the preservation of skills in the musical domain results from an expanded cortical representation of this function in the left hemisphere, secondary to his lifelong formal training, and to the high level of his professional competence. As for his preserved naming of musical instruments, we argue that the early age-of-acquisition and higher than "normal" frequency/familiarity for names of musical instruments facilitate the access to their lexical representation and/or their retrieval within the lexicon.
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7/53. Absence status (petit mal status) with focal characteristics.

    Two patients, aged 23 and 74 years, manifested prolonged episodes of mildly impaired consciousness in conjunction with rhythmical spike waves or spikes (mostly 3/s). This paroxysmal EEG activity was consistently accentuated unilaterally over the superior frontal regions. The first patient showed ictal aphasia and occasional right hemiparesis during these episodes, and partial left frontal lobectomy resulted in temporary freedom from seizures. The classification of these ictal episodes is difficult. They apparently fall into the category of absence status (petit mal status), but the focal neurological signs do not fit the presently valid definitions of absence status, nor does the lack of symmetrical bilateral-synchronous paroxysmal discharges. Perhaps a special category of status epilepticus should be established.
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8/53. Non-convulsive status epilepticus with marked neuropsychiatric manifestations and MRI changes after treatment of hypercalcaemia.

    We describe a 77-year-old woman who developed a confusional state, cognitive impairment, behavioural abnormalities and dysphasia after treatment of hypercalcaemia. Repeated EEG recording revealed rhythmic sharp-wave activity over the right parietal-occipital lobe. magnetic resonance imaging (MRI) showed marked hyperintense signal changes bilaterally. The diagnosis of a non-convulsive status epilepticus (NCSE) was made. With antiepileptic treatment the patient improved and MRI as well as EEG changes were almost all reversible. NCSE is an important differential diagnosis of patients with neuropsychiatric symptoms and can develop after rapid lowering of serum calcium levels in hypercalcaemia.
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9/53. Measurement of the temporal-modulation transfer function for a single listener with cochlear hearing loss and left-hemisphere damage.

    The modulation depth required for the detection of sinusoidal amplitude-modulation applied to a white noise carrier was measured as a function of modulation frequency, giving temporal modulation transfer functions (TMTFs). Five adult listeners with normal hearing (mean age 52 years), five elderly listeners with moderate cochlear hearing loss (mean age 66 years) and a single elderly listener (aged 73 years) with moderate cochlear hearing loss and left-hemisphere damage were tested in the right ear at 50 dB SL. The five elderly listeners were matched in audiogram with the brain-damaged listener. Modulation detection was systematically poorer than normal in the five elderly listeners with cochlear hearing loss. However, their TMTFs were lowpass in shape, as for the five normal-hearing adult listeners. Modulation detection was much poorer in the elderly listener with cochlear hearing loss and left-hemisphere damage compared to the five normal-hearing adults and the five elderly listeners with cochlear hearing loss. Moreover, modulation detection was poorer at 4, 64 and 128 Hz than at 8, 16 and 32 Hz in the brain-damaged listener, giving his TMTF a bandpass appearance. These results are in agreement with the hypothesis that the main factors limiting the ability to detect changes in the temporal-envelope of sounds are located at a central (retro-cochlear) level of the auditory system rather than at a peripheral (cochlear) level. They also suggest that the TMTF approach may prove useful in distinguishing peripheral and central hearing losses.
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10/53. Repeating without semantics: surface dysphasia?

    We describe our investigations of MNA, who had a progressive, severe and global loss of semantic knowledge (semantic dementia). Her verbal vocabulary was restricted to a few common words and she was also unable to recognize common objects from sight. By contrast, she had a well-preserved digit span (7-8 digits). In this series of experiments, we focused on her ability to repeat lists and sentences in which familiarity, meaningfulness, morphology and syntactic structure were manipulated. In list repetition tasks, we found that MNA showed a reliable effect of phonological similarity, word frequency and stimulus lexicality, but was unaffected by linguistic complexity, word length, semantic coherence or the status of individual stimuli as "known" or "unknown". In sentence repetition, her performance was not influenced by any semantic variables. However, there was a substantial effect of the frequency of the constituent vocabulary, even for words outside the range of her retained vocabulary. The influence of syntax was restricted to minor effects of morphology. The phonemes of syllables and the syllables of words are bound by their co-occurrence rather than their meaning. We conclude that the phonological representation of words is functionally independent of the semantic system.
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