Cases reported "Aphasia"

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21/53. Abstract and concrete concepts have structurally different representational frameworks.

    The architecture supporting our conceptual knowledge of abstract words has remained almost entirely unexplored. By contrast, a vast neuropsychological, neurolinguistic and neuroimaging literature has addressed questions relating to the structure of the semantic system underpinning our knowledge of concrete items (e.g. artefacts and animals). In the context of semantic refractory access dysphasia, a series of experiments exploring and comparing abstract and concrete word comprehension are described. We demonstrate that semantically associated abstract words reliably interfere with one another significantly more than semantically synonymous abstract words, while concrete words show the reverse pattern. We report the first evidence that abstract and concrete word meanings are based in representational systems that have qualitatively different properties. More specifically, we show that abstract concepts, but not concrete concepts, are represented in an associative neural network. Furthermore, our patient was found to have significantly greater difficulty in identifying high frequency than low frequency abstract words. This observation constitutes the first evidence of an inverse word frequency effect. Our results challenge the generality of many existing models of human conceptual knowledge, which derive their structure from experimental findings in the concrete domain alone.
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22/53. Periodic episodes of aphasia as an unusual manifestation of partial status epilepticus.

    Recurrent episodes of aphasia due to partial status epilepticus is an uncommon clinical entity. We report here a 78-year-old-woman with episodic aphasia which occurred periodically. During the ictal period, she was conscious, but had difficulty in speech and could not comprehend verbal commands. The ictal EEG showed continuous spike and sharp waves over the left frontotemporal area. After the administration of antiepileptic drugs, her language activity returned to near the baseline level and the epileptic discharges were significantly reduced. Nonconvulsive partial status epilepticus should be considered in the differential diagnosis of recurrent aphasia, even if the symptoms occur periodically.
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23/53. Acquired aphasia, dementia, and behavior disorder with epilepsy and continuous spike and waves during sleep in a child.

    Severe persistent neuropsychological disorders sometimes develop in the course of a focal epilepsy of unknown origin in previously normal children. Very frequent bilateral focal or generalized discharges are often noted on the sleep EEG records of these patients with no evidence of clinical seizures. The relation between these paroxysms and the observed deterioration remains unclear. We report a child with a partial complex epilepsy and severe disturbances of language, cognition, and behavior acquired in the early years of development who was followed for 15 years. A correlation between the evolution of the striking EEG abnormalities during sleep and the neuropsychological disorders could be established retrospectively. The observed sequence of onset and recovery of the aphasia, the dementia, and the "psychotic" behavior makes a direct causal relation between the deficits quite unlikely. Rather it suggests an association of independent symptoms with a specific language disorder becoming manifest in the course of the evolution. This child shows many of the main characteristics of the syndromes of "acquired aphasia with convulsive disorder" (landau-kleffner syndrome) and "epilepsy with continuous spike waves during sleep." Both syndromes describe probably different facets of a similar underlying, still unexplained cerebral dysfunction.
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24/53. Diagnostic and management considerations of acquired epileptic aphasia or landau-kleffner syndrome.

    A small number of children have been identified as having an interruption in their communicative progress known as landau-kleffner syndrome, acquired epileptic aphasia, or aphasia with convulsive disorder. Although presenting symptoms have differed among the cases reported, a progressive or acute language loss and inattentiveness to auditory stimuli are the most common manifestations. Typically, these children begin developing language normally and then, for no apparent reason, language progress is disrupted. This disruption is accompanied by the onset of seizure activity and/or abnormal electroencephalographic (EEG) findings. While this disorder appears to be relatively uncommon, its frequency is questionable due to its unfamiliarity among the audiology and otology communities and, thus, it is subject to the likelihood of misdiagnosis. A case of acquired epileptic aphasia is described herein. A team diagnostic and management approach, which can include audiology, otology, psychology, neurology, and speech-language pathology is recommended for such cases. Earlier identification of this debilitating disorder is needed in order to secure appropriate intervention and reestablish communication systems for these children.
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25/53. writing with the right hemisphere.

    We studied writing abilities in a strongly right-handed man following a massive stroke that resulted in virtually complete destruction of the language-dominant left hemisphere. writing was characterized by sensitivity to lexical-semantic variables (i.e., word frequency, imageability, and part of speech), semantic errors in writing to dictation and written naming, total inability to use the nonlexical phonological spelling route, and agrammatism in spontaneous writing. The reliance on a lexical-semantic strategy in spelling, semantic errors, and impaired phonology and syntax were all highly consistent with the general characteristics of right hemisphere language, as revealed by studies of split-brain patients and adults with dominant hemispherectomy. In addition, this pattern of writing closely resembled the syndrome of deep agraphia. These observations provide strong support for the hypothesis that deep agraphia reflects right hemisphere writing.
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26/53. Transcortical aphasia. Importance of the nonspeech dominant hemisphere in language repetition.

    While a relative preservation of repetition in acute transcortical aphasia (TA) has usually been associated with the functional integrity of the speech dominant (left) perisylvian area, recent amytal data (Bando et al., 1986) have suggested a fundamental role of the nondominant (right) hemisphere in language repetition. The neuroradiological correlates of repetition were studied in a consecutive series of 21 patients with acute TA. A similar frequency of either perisylvian or extraperisylvian pathology was found. In 2 patients with perisylvian pathology, the injection of amytal in the hemisphere contralateral to the lesion abolished repetition. Positron emission tomography (PET) in another patient revealed marked hypometabolism over the entire left cortical mantle ipsilateral to a basal ganglia lesion, suggesting that preserved repetition was carried out by right hemisphere structures. This was confirmed in a second patient with left extraperisylvian pathology, in whom a second lesion in the right hemisphere resulted in impaired repetition. These findings suggest that the spared contralateral hemisphere may subserve residual repetition in some transcortical aphasic patients with a lesion within or outside the speech-dominant perisylvian area.
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27/53. An unlearned foreign "accent" in a patient with aphasia.

    Rarely, aphasics may develop what appears to be a foreign accent, as noted by Monrad-Krohn whose Norwegian patient sounded German. We describe a right-handed native American who developed a foreign accent following damage to the left premotor region and white matter anterior to the head of the left caudate nucleus. Her aphasia was of the transcortical motor type. Both she and her parents were born in the USA, she never traveled outside the country and never learned a foreign language. Phonetic analysis of her voice taped prior to the stroke revealed normal speech with a midwestern accent. In contrast, analyses of her current spontaneous speech, repetition, and reading reveal shifts in vowels, e.g., /I/   /i/, /ae/   /a/; increased diphthonigization; and tense speech posture. These features, which were especially frequent in spontaneous speech, probably explain her "accent." Acoustic analysis of fundamental frequency contours of sentences read in different emotional tones revealed a restricted range and variability of the peaks and valleys.
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28/53. landau-kleffner syndrome. EEG topographic studies.

    Spectral and historical topographic mapping of EEG was done on 2 siblings with landau-kleffner syndrome. The clinical features of the elder sister were acquired aphasia developed at the age of 5, followed by convulsions a year later, and those of the younger brother were progressive ataxia, hemiparesis, urinary incontinence and convulsions at the age of 4 years and 10 months, followed by acquired aphasia a year later. The most prominent spectral mapping features were high spectral powers of delta, theta and alpha waves over the fronto-centro-parietal area. The power of alpha and beta wave bands, reflecting sharp or spike waves, varied spatio-temporally over the central, parietal, temporal and frontal areas. The historical mapping revealed variabilities of paroxysmal discharges in modes of propagation. These results suggested that electrophysiological dysfunction of the fronto-centro-parietal areas associated with markedly unstable paroxysmal discharges is the main feature of landau-kleffner syndrome.
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29/53. landau-kleffner syndrome: a case study with a fourteen-year follow-up.

    In a 14-year follow-up the improvement of language functions and the decrease of EEG abnormalities are described in a girl with the landau-kleffner syndrome. In this case, the results of subsequent EEG recordings do not permit conclusions about the course of the aphasia. Disappearance of focal spike and waves, bilateral paroxysms and slow background activity lack synchronicity with improvement of language. Finally, subtle language deficits were still present 14 years after the onset of the aphasia; the lastly recorded EEG showed mild abnormalities.
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30/53. Acquired aphasia of childhood with epilepsy: the landau-kleffner syndrome.

    The landau-kleffner syndrome is an unusual childhood disorder characterised by an acquired aphasia and a paroxysmal electroencephalographic abnormality with spike and spike and wave discharges which are mostly multifocal and unstable in their course of evolution. Two accessory symptoms are frequently observed: psychomotor or behavioural disturbances and epilepsy. Epileptic seizures are most often generalised convulsive or partial motor and invariably disappear before the age of 15 years. A 20 year old woman is described who has been followed since the rarely observed onset of the landau-kleffner syndrome at the age of 3 years. At 4 years of age she was totally unable to communicate through speech and her EEG showed almost continuous bitemporal spike and spike and wave discharges. Maximum doses of diazepam, phenytoin, carbamazepine and sulthiame were used without effect. From the age of 14 years her ability to communicate through spoken and written language has improved and her EEG now shows no epileptiform activity.
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