Osman Sinanović

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Acta Clin Croat (Suppl. 2) 2011; 4th international epilepsy symposium in Pula – how to start seizure treatment94 Acta Clin Croat,  Vol. 50,  (Suppl) No. 2,  2011CEREBROVASCULAR DISEASES AND LANGUAGE DISORDERSOsman SinanovićDepartment of Neurology, University Clinical Center Tuzla, Medical Faculty University of Tuzla, 75000 Tuzla, Bosnia and HerzegovinaStroke is the third most common cause of death worldwide (after coronary heart disease and all can-cers combined) and the major cause of disability. Th e incidence of stroke varies somewhat from region to region, but has been accurately measured in only a few populations. In western countries incidence for people aged 55 years or more ranges from about 4.2 to 6.5 per 1000 pupulation per annum. Approximately 20% of stroke patients die within one month and about 30% within one year.About one-third remain disabled; the remaining third either recover fully or regain inde-pendence of daily living. Post-stroke language disor-ders are frequent and include aphasia, alexia, agraphia and acalculia. Th ere are diff erent defi nitions of aphasias, but the most widely accepted neurological and/or neuropsy-chological defi nition is that aphasia is a loss or im-pairment of verbal communication which occurs as a consequence of brain dysfunction. It manifests in im-pairment of almost all verbal abilities-abnormal ver-bal expression, diffi  culties in understanding spoken or written language, repetition, naming, reading and writing. During the history, many classifi cations of aphasia syndromes were established. For practical use classifi cation of aphasias according to fl uency, com-prehension and abilities of naming it seems to be most suitable (nonfl uent aphasias: Broca’s, transcoritcal motor, global and mixed transcortical aphasia; fl uent aphasias: anomic, conduction, Wernicke’s, transcorti-cal sensory, subcortical aphasia). Aphasia is common consequence of left hemispheric lesion and most com-mon neuropsychological consequence of stroke, with prevalence of one third of all stroke patients in acute phase although exist reports on greater frequency. Many speech impairments have a tendency of sponta-neous recovery. Spontaneous recovery is most remark-able in fi rst three months after stoke onset. Recovery of aphasias caused by ischemic stroke occurs sooner, and it is the most intensive in the fi rst two weeks. In aphasias caused by hemorrhagic stroke, spontaneous recovery is slower and occurs in the period from the fourth to the eighth weeks after the stroke. Th e course and the outcome of the aphasia depend a lot on the type of aphasia. Regardless of the fact that a signifi -cant number of aphasias spontaneously improves, it is necessary to start the treatment as soon as possible. Th e writing and reading disorders in stroke pa-tients (alexias and agraphias) are more frequent ten it verifi ed in routine exam, not only in the less devel-oped and large neurological departments. Alexia is an acquired type of sensory aphasia where damage to the brain causes a patient to lose the ability to read. It is also called word blindness, text blindness or visual aphasia. Alexia refers to an acquired inability to read caused by brain damage and must be distin-guished from dyslexia, a developmental abnormality in which the individual is unable to learn to read, and from illiteracy, which refl ects a poor educational back-ground. Most aphasics are also alexic, but alexia may occur in the absence of aphasia and may occasionally be the sole disability resulting from specifi c brain le-sions. Th ere are diff erent classifi cations of alexias. Traditionally, the alexias are divided into three cat-egories: pure alexia with agraphia, pure alexia without agraphia, and alexia associated with aphasia («aphasic alexia»).Agraphia is defi ned as the disruption of previously intact writing skills by brain damage. Writing in-Acta Clin Croat,  Vol. 50,  (Suppl) No. 2,  2011 95Acta Clin Croat (Suppl. 2) 2011; 4th international epilepsy symposium in Pula – how to start seizure treatmentvolves several elements – language processing, spell-ing, visual perception, visual-spatial orientation for graphic symbols, motor planning, and motor control of writing. A disturbance of any of these processes can impair writing. Agraphia may occur by itself or n as-sociation with aphasias, alexia, agnosia and apraxia. Agraphia can also result from “peripheral” involve-ment of the motor act of writing. Like alexia, agraphia must be distinguished from illiteracy, where writing skills were never developed.Acalculia is a clinical syndrome of acquired defi -cits in mathematical calculation, either mentally or with paper and pencil. Th is language disturbances can be classifi ed diff erently, but there are three principal types of acalculia: acalculia associated with language disturbances, including number paraphasia, number agraphia, or number alexia; acalculia secondary to visuospatial dysfunction with malalignment of num-bers and columns, and a primary anarithmetria en-tailing disruption of the computation process.Key words: Aphasia – Alexia - Agraphia – Acalcu-lia – StrokeReference1. Sinanovi O. Afazije. U: Sinanović O, Smajlović Dž (ured-nici). Osnove neuropsihologije i neurologije ponašanja. Tuzla: Univerzitet u Tuzli, 2005.2. LaPontine LL. Aphasia and Related Neurogenic Language Disorders.Forth Edition. Th ieme Medica Publishers, Inc: New York, 2011.3. Sarno MT (ed). Acquired Aphasia. 2nd ed. Academic Press: New York, 1991.4. Pedersen PM, Vinter K, Olsen T. Aphasia after stroke: Type, Severity and Prognosis. Cerebrov Dis 2004;1735-1743. 5. Sinanovi O, Vidovi M, Smajlovi Dž. Najčešći neuropsihološki poremećaji u akutnom cerebrovaskularnom inzultu. Liječ Vijesn 2006; 128 (Supl 6): 20-21.  6. Brki E, Sinanovi O, Vidovi M, Smajlovi D. Inci-dence and clinical phenomenology of aphasic disorders after stroke. Med Arh 2009; 63(4): 197-199.  7. Pedersen PM, Vinter K, Olsen TS. Aphasia after Stroke: Type, Severity and Prognosis: Th e Copenhagen Aphasia Study. Cerebrovasc Dis 2004; 17: 35-43.  8. Heilman MK, Valenstein E (eds). Clinical Neuropsychol-ogy. Th ird edition. Oxford University Press: New York, 1993.  9. Sinanovi O, Smajlovi Dž. Aphasia. In: Demarin V, Roje Bedeković M (eds). 20th Anniversary of the International Course “Summer Stroke School – Healthy Life Style and Prevention of Stroke”, Inter-University Center, Dubrovnik: Images and memories from the fi rst 20 years. Zagreb: Croa-tian Stroke Society, 2009: 175-183.10. Sinanovi O. Neuropsychology of acute stroke. Psychiat Danub 2010; 22(2): 278-281.11. Sinanovi O. Aleksije. U: Sinanović O, Smajlović Dž (ured-nici). Osnove neuropsihologije i neurologije ponašanja. Tuzla: Univerzitet u Tuzli, 2005: 83-90.12. Sinanovi O. Agrafi je. U: Sinanović O, Smajlović Dž (ured-nici). Osnove neuropsihologije i neurologije ponašanja. Tuzla: Univerzitet u Tuzli, 2005: 91-95.13. Sinanovi O. Akalkulije. U: Sinanović O, Smajlović Dž (urednici). Osnove neuropsihologije i neurologije ponašanja. Tuzla: Univerzitet u Tuzli, 2005: 70-74.14. Kirshner HS. Aphasia, Alexia, Agraphia, Acalculia. In: Rizzo M, Eslinger PJ (eds). Principles and Practice of Behav-ioral Neurology and Neuropsychology. Philadelphia: W.B. Saunders company, 2004: 389-421. 15. Steven Z, Rapcsak MD, Beeson MP, Henry LM, Ley-den A, Kim E, Rising K, Andersen S, Cho HS. Phono-logical dyslexia and dysgraphia: cogntive mechanisms and neural substrates. Cortex 2009; 45 (5): 575-591. 16. Cummings JL, Mega MS. Disorders of Speech and Lan-guage. In: Cummings JL, Mega MS (eds). Neuropsychiatry and Behavioral Neuroscience. Oxford: Oxfrod University Press, 2003: 70-96. 17. Trapl M, Eckhardt R, Bosak P, Brainin M. Early recog-nition of speech and speech-associated disorders after acute stroke. Wochenschr 2004; 154 823-24): 571-576. 18. Sinanovi O, Mrkonji Z, Zuki S, Imamovi K, Vidovi M. Acta Clin Crota (in press)

Cerebrovascular Diseases and Language Disorders

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