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Ischemic stroke in parietal lobe (computed tomography) in a patient with conductive aphasia. 

Ischemic stroke in parietal lobe (computed tomography) in a patient with conductive aphasia. 

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Post-stroke language disorders are frequent and include aphasia, alexia, agraphia and acalculia. There are different definitions of aphasias, but the most widely accepted neurologic and/or neuropsychological definition is that aphasia is a loss or impairment of verbal communication, which occurs as a consequence of brain dysfunction. It manifests a...

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... adjectives, while the use of nouns remains relatively good. Speech expression is disprosodic be- cause of impairment of rhythm, melody and stress. The way these patients speak sounds similar to tele- grams (‘telegrammatism’). Auditory understanding is maintained and is usu- ally much better than expressive speech. However, understanding of complex grammatical structures and serial orders is usually impaired. The most frequent difficulties are found in understanding of function words and verbs. Relational words are also difficult to understand, such as above/below, bigger/smaller and sentences expressing communication relations such as ‘sister’s mother’ or ‘mother’s sister’. Repetition is poor, usually less impaired than spontaneous speech. Diffi- culties especially occur in repeating complex sentenc- es. The patient simplifies grammar in a sentence. He also shows phonemic distortion and phonemic para- phasia, omitting some phonemes and words. Nam- ing is impaired, as opposed to showing the objects named, which is maintained. Difficulties in naming the objects are usually the consequence of articulatory disorders, not from the loss of lexical knowledge. In some patients, a combination of lexical and articula- tory disorders is possible. Most patients are not able to read aloud or to understand the text they read to themselves. Aphasic writing is also present. Agraphia is manifested in writing large, inappropriately written letters, with literary paragraphy and agrammatism, or ‘telegram writing’ 1-3,17,18 . The majority of patients with Broca’s aphasia have some additional neurologic symptoms such as right side hemiparesis or hemiplegia, ideomotor apraxia of the left arm, and dysarthria. The most frequently used synonym for Wernicke’s aphasia is sensory aphasia, and some other names are also used, e.g., acoustic-amnestic aphasia, receptive aphasia and verbal agnosia. This aphasia is characterized by easy speech pro- duction, and is therefore classified as a fluent apha- sia with a normal or sometimes above normal speech production. Some patients are so logorrheic that they can be stopped only by energetic reaction of the in- terlocutor. Therefore, spontaneous speech in this case has well-preserved articulation and prosody. Speech is characterized by long sentences, which seem gram- matically correct, but is more or less incomprehensible due to a small or large number of literary and verbal paraphasia and neologisms. A person with this kind of aphasia has a very poor understanding of the interlocutor and poor repetition. Repetitive speech is generally impaired in proportion with the degree of auditory understanding. In the highest degree of this syndrome, the content of the speech is completely incomprehensible to the inter- locutor; then we usually say that the patient neither understands what he said nor is he understood. This is opposed to motor aphasia where the examiner has the impression that the patient understands him, but can- not speak correctly or answer the question properly. Communication of a person with sensory aphasia can be compared to a person who is in a foreign country whose language he does not understand or speak 1-3,18 . Naming (objects and events) is impaired, usually to the degree of anomia, and the patient describes the objects he wants to name. Reading is alexic, and writing agraphic. His writing has the same features as his spoken language; he uses long sentences which are regularly shaped, but with paraphasia or neolo- gisms. Unlike motor aphasia, most patients with sensory aphasia have no neurologic symptoms. However, when they are present, it is usually upper quadrantanopsia, or sometimes homonymous hemianopia, hemihyper- esthesia, or mild hemiparesis. Wernicke’s aphasia is usually caused by a lesion in the dominant temporal lobe, especially in the auditory area in the back upper part of the first temporal gyrus (Fig. 2). Conductive aphasia is also called afferent or kin- esthetic motor aphasia, efferent conductive aphasia and central aphasia. This is a relatively rare type of aphasia, accounting for 5%-10% of cases. It is charac- terized by easy production of speech with dominant literary paraphasia. Understanding of the interlocu- tor is relatively good, and so is understanding of the text read, but repetition is outstandingly impaired. Naming is also impaired. Writing is agraphic, and reading alexic, contaminated by paraphasic symp- toms 1,17,18 . This aphasia is clearly different from Wernicke’s aphasia because understanding is much better than repetition. It is different from Broca’s aphasia because production of spontaneous speech is fluent. Ideomotor apraxia, which includes buccofacial and limb activi- ties, is widespread but not a rule. Neurologic symp- toms include a possible, but temporary hemiparesis. Conductive aphasia usually occurs because of a lesion in the back of the perisylvian area of the dominant hemisphere, usually immediately below supramargin- al gyrus (Fig. 3). This is a relatively frequent aphasia, account- ing for 10%-40% of cases. It is also called complete aphasia. Global aphasia is the most serious form of speech disorder. All aspects of speech are impaired, and the patient can usually pronounce just a few words or neologisms. Spontaneous speech is nonfluent, un- derstanding of the interlocutor poor, poor repetition or no repetition at all, and the patient is unable to name objects, read or write (usually complete alexia and agraphia). Speech disorders are usually accom- panied by right-sided hemiplegia or hemiparesis, and hemisensory disorders 1 . The degree of verbal dysfunction and localization of causative pathology may vary. It is usually a lesion of a large area of the left hemisphere (infarction in ir- rigation region of the middle cerebral artery) (Fig. 4). Transcortical motor aphasia or extrasylvian mo- tor aphasia is a nonfluent aphasia which occurs due to damage to the dominant hemisphere outside the speech area or sylvian fissure, which is characterized by a relatively well-preserved ability to repeat. All aphasias that are caused by lesions outside the sylvian fissure are called transcortical. They are usually caused by vascular insufficiency or infarction in the border zone between the middle, anterior and posterior cere- bral artery of the left hemisphere. It can also occur as a consequence of tumor, hemorrhage, infection, and in Alzheimer’s disease 1,2,17,18 . Transcortical motor aphasia is also called dynamic aphasia. The lesion that causes this type of aphasia may be located in the left hemisphere in front of or behind Broca’s area, in the left medial frontal region, also affecting supplementary motor cortex or connec- tions of white matter between these two areas. The main features of this aphasia are difficulties in sponta- neous speech production, relatively or well-preserved understanding of speech, unimpaired repetition, im- paired naming, impaired reading aloud with good un- derstanding of the text read, and impaired writing. This fluent aphasia is characterized by fluent (eas- ily produced) spontaneous speech with paraphasia and echolalia. Echolalia is the basic symptom of this syn- drome and that is why it is often misdiagnosed as a psychiatric disease (psychosis). Understanding of spoken language is considerably impaired, but repetition is intact. Naming, reading and writing are usually considerably impaired. There is variability in reading aloud and impaired under- standing of the text read. The combination of neuro- logic symptoms varies depending on localization and depth of the lesion. The pathologic process that causes this aphasia is usually located in the left parietal and temporal lobe, behind perisylvian area, often in the lower part of the parietal lobe 1,17,18 . This nonfluent extrasylvian aphasia is also called the syndrome of isolation of speech area. It is very rare compared to other types of aphasia. It is a combination of motor and sensory varieties of extrasylvian aphasia with symptoms of global aphasia, except for preserved ability of repetition of spontaneous speech. Spontaneous production of speech is impaired (nonfluent) and echolalic. There is poor understanding of spoken language, poor naming, relatively preserved repetition, impaired reading aloud and understand- ing of the text read, and aphasic writing. Neurologic symptoms are often present, but not constant. Lesions that cause this aphasia affect frontal and posterior borderline zones (between middle cerebral artery on the one side and anterior or posterior cere- bral artery on the other side) of the left hemisphere. Numerous pathologic states accompanied by hypoxia and hypoperfusion of the brain in this region, such as intoxication with carbon-monoxide, acute carotid ar- tery occlusion, acute hypotension, cardiac arrest, etc., may cause mixed transcortical aphasia 1,2,17,18 . In most aphasias, patients have difficulties in find- ing words. However, in anomic aphasia, naming is the main and the most common symptom. It is also called nominal aphasia or amnestic aphasia. It is classified as a fluent aphasia with preserved repetitive speech. Production of spontaneous speech is easy, but the speech is ‘empty’, with long sentences in which the patient tries to replace the missing words with oth- ers (circumlocution). Understanding of spoken lan- guage is good, and repetition is good, too. There is some variability in reading aloud, but understanding of the text is intact. Writing can be aphasic. Location of the lesions which cause this syndrome varies, and anomia can be a consequence of a pathologic process located anywhere in the linguistic zone, and in some cases it is even a consequence of processes located in the right hemisphere. If anomic aphasia is combined with alexia and agraphia and Gertsmann’s syndrome (right-left disorientation, agnosia of fingers, acalculia and agraphia), the lesion usually affects the dominant angular gyrus (Fig. ...

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... Given the clear time course of events in the first context -the cerebral infarction precedes symptoms of receptive aphasia, we expected the additional information, containing folk-neuropsychological knowledge [13], to bias participants' plausibility judgments in favor of a causality from the brain to mind (compared to that in the opposite direction). With respect to musical training, in line with both the common sense that the behavior (early and extensive piano practice) precedes potential brain alterations and scientific findings showing training-induced alterations in gray matter density [14], we expected higher mind to brain plausibility ratings. ...
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