Unusual Aphasias - Crossed Aphasia

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A case of pure apraxia of speech after left hemisphere stroke: behavioral findings and neural correlates

IntroductionApraxia of speech (AOS) is a motor speech disorder impairing the coordination of complex articulatory movements needed to produce speech. AOS typically co-occurs with a non-fluent aphasia, or language disorder, making it challenging to determine the specific brain structures that cause AOS. Cases of pure AOS without aphasia are rare but offer the best window into the neural correlates that support articulatory planning. The goal of the current study was to explore patterns of apraxic speech errors and their underlying neural correlates in a case of pure AOS.MethodsA 67-year-old right-handed man presented with severe AOS resulting from a fronto-insular lesion caused by an ischemic stroke. The participant’s speech and language were evaluated at 1-, 3- and 12-months post-onset. High resolution structural MRI, including diffusion weighted imaging, was acquired at 12 months post-onset.ResultsAt the first assessment, the participant made minor errors on the Comprehensive Aphasia Test, demonstrating mild deficits in writing, auditory comprehension, and repetition. By the second assessment, he no longer had aphasia. On the Motor Speech Evaluation, the severity of his AOS was initially rated as 5 (out of 7) and improved to a score of 4 by the second visit, likely due to training by his SLP at the time to slow his speech. Structural MRI data showed a fronto-insular lesion encompassing the superior precentral gyrus of the insula and portions of the inferior and middle frontal gyri and precentral gyrus. Tractography derived from diffusion MRI showed partial damage to the frontal aslant tract and arcuate fasciculus along the white matter projections to the insula.DiscussionThis pure case of severe AOS without aphasia affords a unique window into the behavioral and neural mechanisms of this motor speech disorder. The current findings support previous observations that AOS and aphasia are dissociable and confirm a role for the precentral gyrus of the insula and BA44, as well as underlying white matter in supporting the coordination of complex articulatory movements. Additionally, other regions including the precentral gyrus, Broca’s area, and Area 55b are discussed regarding their potential role in successful speech production

PICA Performance Following Left or Right Hemisphere Brain Damage: Influence of Side and Severity

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Statistical Power in Aphasia Research

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Discriminant Function Analysis of Performance by Normals and Left Hemisphere, Right Hemisphere, and Bilaterally Brain Damaged Patients on a Word Fluency Measure

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PICA Intrasubtest Variability and Prognosis for Improvement in Aphasia

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Language and Localization: A Comparison of Left, Right, and Bilaterally Brain-Damaged Patients

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Action comprehension in aphasia: linguistic and non-linguistic deficits and their lesion correlates.

Abstract We tested aphasic patients' comprehension of actions to examine processing deficits in the linguistic and non-linguistic domains and their lesion correlates. Twenty-nine left-hemisphere injured patients and 18 age-matched control subjects matched pictured actions (with the objects missing) or their linguistic equivalents (printed sentences with the object missing) to one of two visually-presented pictures of objects. Aphasic patients performed poorly not only in the linguistic domain but also in the non-linguistic domain. A subset of the patients, largely consisting of severe and non-fluent aphasics, showed a greater deficit in the linguistic domain compared with the non-linguistic domain and across the patient group, deficits in the linguistic and non-linguistic domains were not tightly correlated. Poor performance in pantomime interpretation was associated with lesions in the inferior frontal, premotor and motor cortex, a portion of somatosensory cortex, and the caudate, while poor reading comprehension of actions was associated with lesions around the anterior superior temporal lobe, the anterior insula and the anterior portion of the inferior parietal lobe. Lesion size did not correlate with deficits. The lesion results for pantomime interpretation deficits demonstrate that lesions in the frontal component of the human analog of the "mirror neuron system" are associated with deficits in non-linguistic action understanding. For reading comprehension deficits, the lesion correlates are brain areas known to be involved in linguistic tasks including sentence processing and speech articulation; the parietal lesion site may also correspond to a subpart of the human mirror neuron system. These results indicate that brain areas important for the production of language and action are also recruited in their comprehension. Similar findings have been reported in electrophysiological and neuroimaging studies. Our findings now also lend neuropsychological support to an embodied view of brain organization for action processing

Spatiotemporal Dynamics of Word Processing in the Human Brain

We examined the spatiotemporal dynamics of word processing by recording the electrocorticogram (ECoG) from the lateral frontotemporal cortex of neurosurgical patients chronically implanted with subdural electrode grids. Subjects engaged in a target detection task where proper names served as infrequent targets embedded in a stream of task-irrelevant verbs and nonwords. Verbs described actions related to the hand (e.g, throw) or mouth (e.g., blow), while unintelligible nonwords were sounds which matched the verbs in duration, intensity, temporal modulation, and power spectrum. Complex oscillatory dynamics were observed in the delta, theta, alpha, beta, low, and high gamma (HG) bands in response to presentation of all stimulus types. HG activity (80–200 Hz) in the ECoG tracked the spatiotemporal dynamics of word processing and identified a network of cortical structures involved in early word processing. HG was used to determine the relative onset, peak, and offset times of local cortical activation during word processing. Listening to verbs compared to nonwords sequentially activates first the posterior superior temporal gyrus (post-STG), then the middle superior temporal gyrus (mid-STG), followed by the superior temporal sulcus (STS). We also observed strong phase-locking between pairs of electrodes in the theta band, with weaker phase-locking occurring in the delta, alpha, and beta frequency ranges. These results provide details on the first few hundred milliseconds of the spatiotemporal evolution of cortical activity during word processing and provide evidence consistent with the hypothesis that an oscillatory hierarchy coordinates the flow of information between distinct cortical regions during goal-directed behavior

PICA Performance by Traumatically Brain Injured and Left Hemisphere CVA Patients

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