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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 39-year-old man suffered an intracerebral hemorrhage in the region of the left internal capsule deep to Wernicke's area. The location of the lesion was confirmed by computerized tomography (CT) performed two days postictally. Two weeks after admission, the Boston Diagnostic Aphasia Examination (BDAE) diclosed Wernicke's aphasia. We hypothesize that the hematoma exerted pressure on Wernicke's cortical area, thus causing the resulting Wernicke's aphasia at that time. A CT scan three months later showed absorption of the hematoma, with a residual low-density lesion deep to Wernicke's area, in the region of the arcuate fasciculus. At that time, BDAE testing disclosed a mild conduction aphasia. Serial CT scanning combined with discriminating clinical evaluation of aphasia provides a valuable opportunity for study of the processes underlying stroke resolution and aphasia.
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PMID:The resolving stroke and aphasia. A case study with computerized tomography. 42 69

We studied clinical characteristics and coexisting causes of stroke in 305 patients admitted to a population-based primary care center with an initial ischemic stroke and a potential cardiac source of embolism (PCSE). Using systematic standardized cardiac, arterial, and cerebral investigations and the logistics of the prospective Lausanne Stroke Registry, we found that nonprogressive onset, hemianopia without hemiparesis or hemisensory disturbances, Wernicke's aphasia, ideomotor apraxia, involvement of specific territories (posterior division of middle cerebral artery, anterior cerebral artery, cerebellum, multiple territories), and a hemorrhagic component were associated with the presence of a PCSE, as compared with 1,006 initial ischemic stroke patients without PCSE. Although age and sex did not differ, the frequency of hypertension, diabetes, cigarette smoking, elevated blood cholesterol, and deep hemispheric or brainstem infarcts was higher in the patients without a PCSE. Nearly one-fourth of the patients with a PCSE had a coexisting potential arterial cause of stroke (large artery greater than or equal to 50% stenosis or small-vessel disease). In the majority of patients with a PCSE (76.7%), cardioembolism was the most likely cause of stroke, although a direct source of embolism was uncommon (4.3%) and intracranial embolic occlusions were present in less than one-half of the patients who were angiographed.
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PMID:Cardiac sources of embolism and cerebral infarction--clinical consequences and vascular concomitants: the Lausanne Stroke Registry. 204 30

A patient who already had Wernicke's aphasia due to a left temporal lobe lesion suffered a severe deterioration specifically of auditory language comprehension, subsequent to right temporal lobe infarction. A detailed comparison of his new condition with his language status before the second stroke revealed that the newly acquired deficit was limited to tasks related to auditory input. Further investigations demonstrated a speech perceptual disorder, which we analysed as due to deficits both at the level of general auditory processes and at the level of phonetic analysis. We discuss some arguments related to hemisphere specialization of phonetic processing and to the disconnection explanation of word deafness that support the hypothesis of word deafness being generally caused by mixed deficits.
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PMID:Word deafness and auditory cortical function. A case history and hypothesis. 206 46

We studied 305 patients with a first stroke and a potential cardiac source of embolism (PCSE), on the basis of the Lausanne Stroke Registry. We have compared these patients with 1006 patients with stroke but without PCSE, admitted into the Registry during the same period, in order to assess the potential role of PCSE and the coexistence of other causes of stroke. Analysis of the various types of PCSE suggests that some neurologic characteristics are more frequent in patients with than without PCSE (infarcts of the posterior division of middle cerebral artery with Wernicke's aphasia and lateral hemianopia; maximal neurologic deficit at onset; haemorrhagic infarcts).
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PMID:[Cardiac sources of cerebral embolism and infarction: results of the Lausanne register for cerebrovascular accidents]. 221 52

The speech characteristics on a standardized picture description task of 26 subjects with presumed senile dementia of the Alzheimer type (SDAT) and 13 subjects with stroke-related dementia (SRD) were compared to 15 normal subjects over age 59 years. Compared to the normal subjects, the dementia subjects used fewer total words, fewer unique words, fewer prepositional phrases, fewer subordinate clauses, and more incomplete sentence fragments. Lexical deficits tended to be more severe than syntactic ones, confirming prior suggestions that lexicon is more vulnerable to disruption in dementia than syntax. Greater dementia severity among the SDAT subjects was associated with marked difficulties in accessing the mental lexicon (increased use of empty words, indefinite anaphora, and pronouns). Greater dementia severity in the SRD subjects was associated with laconic speech that was syntactially less complex. Diffuse brain injury (as typified by SDAT) appears to disproportionately affect lexicon whereas multifocal injury (as typified by SRD) has a disproportionate effect on syntax (assuming that focal lesions of the posterior language zone have been excluded). The speech characteristics of the mild SDAT subjects showed similarities to those of anomic or semantic aphasia whereas the speech of the more advanced SDAT subjects showed similarities to Wernicke aphasia or transcortical sensory aphasia. The speech of the subjects with more severe SRD showed some similarities to Broca aphasia. The most important nonlinguistic deficit in both the SRD and the SDAT groups was a failure to make relevant observations during the picture description task. Perseverations were present in the speech of both the SRD and SDAT subjects, whereas aposiopesis, logorrhea, and palilalia were more typical of the SDAT subjects. Laconic speech was more characteristic of the SRD subjects.
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PMID:Language disintegration in dementia: effects of etiology and severity. 241 34

Aphasia therapy in adults has been established to a larger extent relatively lately in the history of aphasiology, i.e. after its social medical importance had been realized and one of the cardinal problems of neurology solved more satisfactorily--lesion localization by imaging techniques. In order to evaluate the efficiency of aphasia therapy--which is still not quite uncontradicted--it was necessary to acquire sufficient knowledge of the spontaneous recovery process. It takes place--e.g. after stroke--mainly during the first 3 months, coming, as a rule, to a halt during the first year. Longer recovery periods, however, have been described. Next to etiology neurological status, overall health condition, type and severity of aphasia, and time delay between onset of the disease and start of therapy have been ascertained, whereas age and handedness seem to be of minor relevance. If syndrome change occurs the boundary between Broca's and Wernicke's aphasia is not surpassed; this taken apart almost any change from a more severe to a milder form of aphasia is possible. To isolate the therapeutic effect from spontaneous recovery in larger groups is difficult. There are, however, more recent investigations which suggest, that a correctly indicated therapy, which is sufficiently intensive and lasts long enough, will be effective. One of the corner-stones of any therapeutic effort ist adequate stimulation, oriented toward the patients needs and his aphasic syndrome, and taking into account the systemic nature of language and its most important linguistic structural components. Furthermore, a phase-specific and interdisciplinary approach and integration of closely related persons play an important role. We divide the numerous therapeutic techniques into 3 groups: direct or stimulation approach, indirect or circumventory approach, compensatory or alternative strategies approach. Representatives of all 3 groups are presented briefly, e.g. auditory stimulation, divergent semantic intervention, promoting aphasics communicative effectiveness, language enrichment therapy, programmed instruction; then the deblocking method, melodic intonation therapy, imagery, a sample of linguistically oriented methods for the reeducation of syntax, semantics, and phonemics along with special methods for the treatment of alexia and agraphia; finally compensatory techniques like visual communication, visual action therapy, and bliss symbolics. Some particular problems encountered in working with aphasics are addressed. A point is made about the feasibility and profit of lay therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Current status of aphasia therapy]. 242 25

To obtain further insights into the rehabilitation outlook in different baseline conditions, a comparison was made of data and treatment outcomes in 92 patients having aphasias of different etiology and disease duration. Rating as "improved" was contingent on significant changes in at least 2 subtests of the AAT (Aachener Aphasietest), which is a fairly stringent requirement. This criterion was met by some 35% of the patients overall, independent of their age; the percentage increased to 45% in case of treatment onset during the first year, while in later onset, significant improvement was achieved in 15% only. Aphasic syndromes secondary to hemorrhage, trauma, tumors, or infections, usually are less severe than the predominant classical syndromes, i.e. Global, Broca and Wernicke aphasia, caused by ischemic stroke. CT lesion size did not yield any definite information. Minor improvements below the required significance levels, and, above all, gains in communication performance, i.e. further consolidation, could be achieved by appropriate management even after the crucial initial year, which, however, does not imply any fundamental changes in the rehabilitation prognosis as such.
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PMID:[Rehabilitation prognosis of aphasias of various etiologies with reference to clinical, neurolinguistic and computerized tomography findings]. 245 41

We reviewed 49 patients with Wernicke's aphasia resulting from a stroke. Their aphasia was classified on the basis of comprehensive neuropsychological testing. Wernicke's aphasia was more common in older patients and in men. Cerebral infarction occurred in 38 patients (78%) and intracerebral hemorrhage in seven (14%); the remaining four patients (8%) developed aphasia after surgery for aneurysmal subarachnoid hemorrhage. Embolic events were the most common etiology of Wernicke's aphasia in the 38 patients with cerebral infarction, with cardiac emboli in 40% and large-vessel atheroemboli from a carotid source in 16%. In patients with Wernicke's aphasia secondary to infarction, an embolic source should be sought. Patients with Wernicke's aphasia should have computed tomography to exclude intracerebral hemorrhage before institution of anticoagulant therapy.
Stroke 1989 Dec
PMID:Etiology of stroke in patients with Wernicke's aphasia. 259 36

A 70-yr-old man was able to read aloud, without comprehending what he read, following a stroke that caused Wernicke's aphasia with severely impaired comprehension of speech. Tested on admission, and at 3 and 9 months, he could read aloud both orthographically simple and orthographically complex real words, and showed neither semantic errors, preference for nouns, nor difficulty with function words. He could not, however, read aloud orthographically simple nonwords. His disorder thus appears to be the first pure example of 'direct dyslexia', which, in contrast to previously well-documented examples of 'deep' and 'surface' dyslexia, implies the existence in reading of a direct route, independent of phonology or semantics, between visual and oral word representations.
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PMID:Direct dyslexia. Preserved oral reading of real words in Wernicke's aphasia. 273 Oct 22

The hypothesis that the language disorder in Alzheimer's disease (AD) depends on degenerative brain changes in classical left-hemisphere language zones was tested by comparing the written language performances of a group of AD patients with mild-moderate dementia and left-hemisphere stroke patients with equally severe naming and auditory comprehension deficits who were in varying stages of recovery from Wernicke's aphasia. The results indicated significant qualitative group differences in performances between tasks and in errors within tasks. The findings are consistent with hypothesized disruption of more diffusely organized neurolinguistic systems in AD. The hypothesis that the language disorder in AD represents an exaggeration of the pattern of language change in normal aging was also examined by comparing the performances of AD patients to the changes that occur with very advanced normal aging. The data indicate convergence between AD and very elderly healthy subjects in some aspects of written language production.
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PMID:Linguistic and nonlinguistic impairments in writing: a comparison of patients with focal and multifocal CNS disorders. 280 19


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