STUDY - Technical - New Dacian's Medicine
Aphasia
and other Focal Disorders (2)
Translation Draft
I will now approach the Wernicke aphasia.
I will now approach the Wernicke aphasia.
The understanding of
written and spoken language is altered. Speech is fluent and
maintains the right tone, but it is intensely paraphrased and
locomotor. The tendency to paraphrase errors can be so
pronounced that it leads to the stringing of neologisms that
form the basis of what is known as "jargonophasia".
The speech contains a large number of functional words (prepositions, conjunctions), but few nouns or verbs that indicate specific actions. Thus, the message is rich, but has no informative value. For example, a 76-year-old man was taken to the emergency room because he started talking "weird" while playing cards.
For understanding I will describe the dialogues that followed the action of the wife who accidentally threw something important, probably the dentures: "We don't need it anymore," she said. a... of... dentis... My dentist. And it just happened to be in the bag... You see, I'm not going How could something like this happen? So she says we don't need them... I didn't think I used them. And now if I have any problem anyone comes a month from now, four months from now or six months from now, I have a new dentist. Where the two... two little pieces of dentist that I used... which I... all gone. If she throws everything away... visit some of her friends and she can't throw them away."
Gestures and pantomime do not improve communication. the patient does not seem to realize that his language is incomprehensible and may become angry or impatient when the examiner cannot decipher the meaning of the intensely paraphrased phrases. In some patients this type of aphasia may be accompanied by severe agitation and paranoid behavior.
One aspect of understanding, which can be preserved, is the ability to execute commands related to the axial musculature. The dissociation between the inability to understand simple questions ("What's your name?") in a patient who quickly closes his eyes, stands up or rolls when asked to do these things, is characteristic of Wernicke's aphasia and helps to differentiate it from deafness, mental illness or simulation.
Patients with Wernicke aphasia cannot express their thoughts in words with the right meaning and cannot decode the meaning of the words of any type of communication. Thus, this type of aphasia has both expression and reception components and should not be designated as "sensory aphasia" or "reception aphasia", two terms that are commonly used as synonyms for Wernicke aphasia. In addition to paraphasic speech and difficult understanding of spoken language, patients with Wernicke aphasia also have repeated speech, appointment, reading and writing altered.
The localization of lesions most commonly associated with Wernicke aphasia are at the back of the language network and tend to occupy at least areas of the Wernicke area. An embolus in the lower segment of the middle cerebral artery, and especially in the posterior or angular temporal branches, is the most common etiology.
Intracerebral haemorrhage, venous infarction, severe head trauma or neoplasm are other causes. The coexistence of a hemianopsia or an anopsia in the upper quadrant is common in patients with Wernicke aphasia. A slight right nasolabial flattening may also be encountered, but otherwise the physical examination is irrelevant.
The paraphasic speech, with neologisms, of a agitated patient, whose neurological examination is almost normal, can lead to suspicion of a primary mental illness, such as schizophrenia or manic syndrome, but the existence of other manifestations of acquired aphasia and the absence of psychiatric history usually clear up the problem. The prognosis of recovery is reserved in most cases, some patients with Wernicke aphasia due to intracerebral haemorrhage or head trauma may recover as the causative lesions heal.
Let's move on to Broca aphasia now. Here, the speech is devoid of fluency, cumbersome, dizartric and interrupted by many breaks in which the patient searches for his words. It is poor in functional words, but richer in nouns and verbs with proper meaning. The abnormal order of words and the incorrect use of connecting morphemes (parts of the word indicating time, possessive or plural) lead to specific agramatism.
The message is telegraphed, but it contains enough information. In the following passage, a man with Broca aphasia, 45, describes his medical history: "I understand... the dotor, the dotor sent me... I'm going to the hospital. The dotor... He kept me out of the way. Two, two days, the dotor sent me home." Verbal expression may be reduced to a grunt or a single word ("yes" or "no"), issued on different intonations, in an attempt to express agreement or disagreement.
Apart from fluency, appointment and repeated speech are altered. Understanding the spoken message is intact, except for syntactically difficult phrases, with structures at passive diathesis or secondary sentences. The comprehension of reading is also preserved, except for the specific inability to read short words such as conjunctions or pronouns.
The last two characteristics show that Broca aphasia is not just a "speech" or "motor" disorder, it may also involve a deficit in the understanding of functional words and syntax. Patients with Broca aphasia are fearful, frustrated and deeply depressed. Their state awareness is preserved, unlike Wernicke aphasia.
Even when spontaneous speech is intensely dysartrical, the patient may be able to articulate relatively normally the words by singing them. This dissociation has been used to develop a specific therapeutic approach (melodic intonation therapy) to treat patients with Broca aphasia.
Additional neurological deficits in these patients are right facial weakness, hemiparesis or hemiplegia and bucofacial apraxia characterized by an inability to perform motor commands that train the oropharyngeal and facial muscles (for example, the patient cannot blow to extinguish a match or draw fluid through a straw). The field of vision is bilaterally intact.
The cause of aphasia is most often a infarction in the Broca area (lower frontal circumvolution) and the insular and perisylvian anterior cortex, due to occlusion of the upper segment of the cerebral artery. Mass-effect injuries such as tumours (primary or metastatic), intracerebral or subdural haemorrhages, or abscesses may present as Broca aphasia. Small lesions, limited to the posterior part of the Broca area can lead to a deficit in word articulturism, nonaphasic and often reversible.
In many cases, the intact parts of the language network appear to be sufficient to support its essential functions. The patient frequently presents with limited motor deficits, e.g. isolated facial weakness. In contrast, patients with hemiparesis or hemiplegia have larger lesions and recovery prospects are less favorable. In the case of a stroke, the recovery of language functions reaches a maximum in a few months, after which there is no further progress.
Let's continue with global aphasia! In this case, the speech is devoid of fluency, and the understanding of spoken language is severely altered. Appointment, repeated speech, reading and writing are also affected. This syndrome reflects the combined damage to the Boca and Wernicke areas and is generally caused by a stroke covering all branches of the middle cerebral artery in the left hemisphere.
At first, most patients are mute or can only say a few words, such as "hello" or "yes". Associated symptoms are right hemiplegia, loss of sensitivity in the same area and homonopsia homolymous. Sometimes a patient with a lesion in the Wernicke area presents with global aphasia which then evolves towards Wernicke aphasia.
In this case, the alteration of fluency (which initially gives the impression of global aphasia) occurs by a mechanism analogous to that of spinal or diaschizis shock, when a dysfunction of a component of the network leads to a remote, reversible dysfunction of other components of the network.
In the case of leadership aphasia, speech is fluent, but paraphrase, comprehension of spoken language is intact and repeated speech is severely altered. Appointment and writing are also affected, reading aloud is altered, but comprehension of the written text is preserved. This type of aphasia reflects a disruption of connections to the anterior and posterior poles of the language network.
As a result of this disconnection, the neural representation of the words forming in the Wernicke area and adjacent regions cannot be transmitted to the Broca area in order to be integrated into appropriate articulation schemes. The lesions spare the Wernicke and Broca areas, but affect the projection pathways linking the two Perisylvian regions or neighbouring areas, such as the island or the supramarginal gyrus.
Sometimes a lesion in the Wernicke area causes a transient Wernicke aphasia, which quickly turns into driving aphasia. Paraphraseal speech in driving aphasia interferes with the ability to express meaning, but this deficiency is nowhere near as severe as that which occurs in patients with Wernicke aphasia. Neurological signs associated with driving aphasia vary depending on the location of the primary lesions.
In nonfluent transcortical aphasia (transcortical motor area), the clinical characters are similar to those of Broca aphasia, but repeated speech is intact and agramatism may be slightly more pronounced. The rest of the neurological exam may be normal or there may be a right hemiparesis.
The lesion leaves the center of the neural network intact, but disconnects it from the prefrontal areas of the cortex. Characteristic localizations of lesions are the anterior half of the vascular crossing area, located in the territories of the anterior and middle cerebral arteries or additional motor cortex in the territory of the anterior cerebral artery.
I will continue with other forms of aphasia in the next post!
The speech contains a large number of functional words (prepositions, conjunctions), but few nouns or verbs that indicate specific actions. Thus, the message is rich, but has no informative value. For example, a 76-year-old man was taken to the emergency room because he started talking "weird" while playing cards.
For understanding I will describe the dialogues that followed the action of the wife who accidentally threw something important, probably the dentures: "We don't need it anymore," she said. a... of... dentis... My dentist. And it just happened to be in the bag... You see, I'm not going How could something like this happen? So she says we don't need them... I didn't think I used them. And now if I have any problem anyone comes a month from now, four months from now or six months from now, I have a new dentist. Where the two... two little pieces of dentist that I used... which I... all gone. If she throws everything away... visit some of her friends and she can't throw them away."
Gestures and pantomime do not improve communication. the patient does not seem to realize that his language is incomprehensible and may become angry or impatient when the examiner cannot decipher the meaning of the intensely paraphrased phrases. In some patients this type of aphasia may be accompanied by severe agitation and paranoid behavior.
One aspect of understanding, which can be preserved, is the ability to execute commands related to the axial musculature. The dissociation between the inability to understand simple questions ("What's your name?") in a patient who quickly closes his eyes, stands up or rolls when asked to do these things, is characteristic of Wernicke's aphasia and helps to differentiate it from deafness, mental illness or simulation.
Patients with Wernicke aphasia cannot express their thoughts in words with the right meaning and cannot decode the meaning of the words of any type of communication. Thus, this type of aphasia has both expression and reception components and should not be designated as "sensory aphasia" or "reception aphasia", two terms that are commonly used as synonyms for Wernicke aphasia. In addition to paraphasic speech and difficult understanding of spoken language, patients with Wernicke aphasia also have repeated speech, appointment, reading and writing altered.
The localization of lesions most commonly associated with Wernicke aphasia are at the back of the language network and tend to occupy at least areas of the Wernicke area. An embolus in the lower segment of the middle cerebral artery, and especially in the posterior or angular temporal branches, is the most common etiology.
Intracerebral haemorrhage, venous infarction, severe head trauma or neoplasm are other causes. The coexistence of a hemianopsia or an anopsia in the upper quadrant is common in patients with Wernicke aphasia. A slight right nasolabial flattening may also be encountered, but otherwise the physical examination is irrelevant.
The paraphasic speech, with neologisms, of a agitated patient, whose neurological examination is almost normal, can lead to suspicion of a primary mental illness, such as schizophrenia or manic syndrome, but the existence of other manifestations of acquired aphasia and the absence of psychiatric history usually clear up the problem. The prognosis of recovery is reserved in most cases, some patients with Wernicke aphasia due to intracerebral haemorrhage or head trauma may recover as the causative lesions heal.
Let's move on to Broca aphasia now. Here, the speech is devoid of fluency, cumbersome, dizartric and interrupted by many breaks in which the patient searches for his words. It is poor in functional words, but richer in nouns and verbs with proper meaning. The abnormal order of words and the incorrect use of connecting morphemes (parts of the word indicating time, possessive or plural) lead to specific agramatism.
The message is telegraphed, but it contains enough information. In the following passage, a man with Broca aphasia, 45, describes his medical history: "I understand... the dotor, the dotor sent me... I'm going to the hospital. The dotor... He kept me out of the way. Two, two days, the dotor sent me home." Verbal expression may be reduced to a grunt or a single word ("yes" or "no"), issued on different intonations, in an attempt to express agreement or disagreement.
Apart from fluency, appointment and repeated speech are altered. Understanding the spoken message is intact, except for syntactically difficult phrases, with structures at passive diathesis or secondary sentences. The comprehension of reading is also preserved, except for the specific inability to read short words such as conjunctions or pronouns.
The last two characteristics show that Broca aphasia is not just a "speech" or "motor" disorder, it may also involve a deficit in the understanding of functional words and syntax. Patients with Broca aphasia are fearful, frustrated and deeply depressed. Their state awareness is preserved, unlike Wernicke aphasia.
Even when spontaneous speech is intensely dysartrical, the patient may be able to articulate relatively normally the words by singing them. This dissociation has been used to develop a specific therapeutic approach (melodic intonation therapy) to treat patients with Broca aphasia.
Additional neurological deficits in these patients are right facial weakness, hemiparesis or hemiplegia and bucofacial apraxia characterized by an inability to perform motor commands that train the oropharyngeal and facial muscles (for example, the patient cannot blow to extinguish a match or draw fluid through a straw). The field of vision is bilaterally intact.
The cause of aphasia is most often a infarction in the Broca area (lower frontal circumvolution) and the insular and perisylvian anterior cortex, due to occlusion of the upper segment of the cerebral artery. Mass-effect injuries such as tumours (primary or metastatic), intracerebral or subdural haemorrhages, or abscesses may present as Broca aphasia. Small lesions, limited to the posterior part of the Broca area can lead to a deficit in word articulturism, nonaphasic and often reversible.
In many cases, the intact parts of the language network appear to be sufficient to support its essential functions. The patient frequently presents with limited motor deficits, e.g. isolated facial weakness. In contrast, patients with hemiparesis or hemiplegia have larger lesions and recovery prospects are less favorable. In the case of a stroke, the recovery of language functions reaches a maximum in a few months, after which there is no further progress.
Let's continue with global aphasia! In this case, the speech is devoid of fluency, and the understanding of spoken language is severely altered. Appointment, repeated speech, reading and writing are also affected. This syndrome reflects the combined damage to the Boca and Wernicke areas and is generally caused by a stroke covering all branches of the middle cerebral artery in the left hemisphere.
At first, most patients are mute or can only say a few words, such as "hello" or "yes". Associated symptoms are right hemiplegia, loss of sensitivity in the same area and homonopsia homolymous. Sometimes a patient with a lesion in the Wernicke area presents with global aphasia which then evolves towards Wernicke aphasia.
In this case, the alteration of fluency (which initially gives the impression of global aphasia) occurs by a mechanism analogous to that of spinal or diaschizis shock, when a dysfunction of a component of the network leads to a remote, reversible dysfunction of other components of the network.
In the case of leadership aphasia, speech is fluent, but paraphrase, comprehension of spoken language is intact and repeated speech is severely altered. Appointment and writing are also affected, reading aloud is altered, but comprehension of the written text is preserved. This type of aphasia reflects a disruption of connections to the anterior and posterior poles of the language network.
As a result of this disconnection, the neural representation of the words forming in the Wernicke area and adjacent regions cannot be transmitted to the Broca area in order to be integrated into appropriate articulation schemes. The lesions spare the Wernicke and Broca areas, but affect the projection pathways linking the two Perisylvian regions or neighbouring areas, such as the island or the supramarginal gyrus.
Sometimes a lesion in the Wernicke area causes a transient Wernicke aphasia, which quickly turns into driving aphasia. Paraphraseal speech in driving aphasia interferes with the ability to express meaning, but this deficiency is nowhere near as severe as that which occurs in patients with Wernicke aphasia. Neurological signs associated with driving aphasia vary depending on the location of the primary lesions.
In nonfluent transcortical aphasia (transcortical motor area), the clinical characters are similar to those of Broca aphasia, but repeated speech is intact and agramatism may be slightly more pronounced. The rest of the neurological exam may be normal or there may be a right hemiparesis.
The lesion leaves the center of the neural network intact, but disconnects it from the prefrontal areas of the cortex. Characteristic localizations of lesions are the anterior half of the vascular crossing area, located in the territories of the anterior and middle cerebral arteries or additional motor cortex in the territory of the anterior cerebral artery.
I will continue with other forms of aphasia in the next post!
Have a good, good, good
day!
Dorin, Merticaru