[A case of conduction aphasia with specific jargon utterance].

We report a patient with bilateral hemispheric lesions caused by two episodes of cerebral infarction who exhibited conduction aphasia with unique jargon. The patient was an 84-year-old, right-handed man. Beginning after the second episode of cerebral infarction (defined as the time of symptom onset), neologistic jargon and an iterative pattern of phonemic variation became prominent, whereas phonological paraphasia and conduite d'approche were observed in the patient's overall speech. Therefore, the aphasia was characterized by the combination of conduction aphasia and neologistic jargon. At 27 months after symptom onset, the neologisms and iterative pattern of phonemic variation had disappeared, but a wide variety of phonological paraphasia and conduite d'approche persisted, clarifying the pathological features of the conduction aphasia experienced by this patient. The conduction theory (Kertesz et al., 1970) provides a convincing explanation for the mechanism of the onset of neologisms in the present case. Thus, we propose the existence of a symptomatic relationship between neologisms and phonological paraphasia.

COVID-19 presenting with agraphia and conduction aphasia in a patient with left-hemisphere ischemic stroke.

COVID-19 following infection by SARS-CoV-2 can affect the brain causing confusion, depression, and dementia-like signs. Nonetheless, the presence of more specific neuropsychological signs because of COVID-19 remains unexplored. We report on LA, a patient who was affected by a left-hemisphere ischemic stroke, probably because of SARS-CoV-2. The patient showed a highly specific neuropsychological profile characterized by severe agraphia and some signs of conduction aphasia. All other cognitive and sensorimotor functions remained intact. We sustain that specific neuropsychological signs can be observed in patients with COVID-19. Therefore, in-depth and comprehensive neuropsychological assessment should be included to better explore and qualify the neuropsychological consequences of COVID-19. This is a new challenge for diagnosis and rehabilitation, with important consequences for the involved neuropsychological services.

An Exploration of the Impact of Group Treatment for Aphasia on Connected Speech.

OBJECTIVE: Group treatment enables people with aphasia to practise communication skills outside the typical clinician-patient dyad. While there is evidence that this treatment format can improve participation in everyday communication, there is little evidence it impacts linguistic abilities. This project aimed to investigate the effects of 'typical' group treatment on the communication skills of people with aphasia with a focus on word retrieval in discourse. METHODS: Three people with aphasia took part in a 6-week group therapy programme. Each week focused on a different topic, and three topics also received a home programme targeting word retrieval. The six treated topics were compared with two control topics, with regard to language production in connected speech. Semistructured interviews were collected twice prior to treatment and twice following the treatment and analysed using (a) word counts; (b) the profile of word errors and retrieval in speech; (c) a measure of propositional idea density, and (d) perceptual discourse ratings. RESULTS: Two participants showed no significant improvements; one participant showed significant improvement on discourse ratings. CONCLUSIONS: This study provides limited support for group treatment, leading to improved communication as measured by semistructured interviews, even when supplemented with a home programme. We suggest that either group treatment, as implemented here, was not an effective approach for improving communication for our participants and/or that outcome measurement was limited by difficulty assessing changes in connected speech.

Developmental conduction aphasia after neonatal stroke.

OBJECTIVE: Impairment of speech repetition following injury to the dorsal language stream is a feature of conduction aphasia, a well-described "disconnection syndrome" in adults. The impact of similar lesions sustained in infancy has not been established. METHODS: We compared language outcomes in term-born individuals with confirmed neonatal stroke (n = 30, age = 7-18 years, left-sided lesions in 21 cases) to matched controls (n = 40). Injury to the dorsal and/or ventral language streams was assessed using T1 - and T2 -weighted magnetic resonance imaging (MRI) and diffusion tractography. Language lateralization was determined using functional MRI. RESULTS: At the group level, left dorsal language stream injury was associated with selective speech repetition impairment for nonwords (p = 0.021) and sentences (p < 0.0001). The majority of children with significant repetition impairment had retained left hemisphere language representation, but right hemisphere dominance was correlated with minimal or absent repetition deficits. Post hoc analysis of the repetition-impaired group revealed additional language-associated deficits, but these were more subtle and variable. INTERPRETATION: We conclude that (1) despite the considerable plasticity of the infant brain, early dorsal language stream injury can result in specific and long-lasting problems with speech repetition that are similar to the syndrome of conduction aphasia seen in adults; and (2) language reorganization to the contralateral hemisphere has a protective effect. Ann Neurol 2018;83:664-675 Ann Neurol 2018;83:664-675.

rTMS treatments combined with speech training for a conduction aphasia patient: A case report with MRI study.

RATIONALE: To date, little is known regarding the neural mechanisms of the functional recovery of language after repetitive transcranial magnetic stimulation (rTMS) in aphasia. Our aim was to investigate the mechanism that underlies rTMS and speech training in a case report. PATIENT CONCERNS AND DIAGNOSES: We report the case of a 39-year-old woman who was initially diagnosed with conduction aphasia following a left hemisphere stroke. INTERVENTIONS: The rTMS location comprised the left Broca area, and a frequency of 5 Hz for 20 min/d for 10 days during a 2-week period was used. She had received speech rehabilitation training 1 month after stroke. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging were used to investigate the functional and microstructural changes before and after rTMS treatment. OUTCOMES: The results demonstrated that the Western Aphasia Battery scores significantly improved for language ability at 2 weeks post-treatment, and the gains were steadily increased at 2.5 months post-treatment. The fMRI results indicated a more focused activation pattern and showed significant activation in the left dominant hemisphere relative to the right hemisphere, especially in the perilesional areas, post-treatment during 2 language tasks compared with pretreatment. Moreover, the fractional anisotropy increased in the left superior temporal gyrus, which comprises an important area that is involved in language processing. LESSONS: Our findings suggest that rTMS combined with speech training improved the speech-language ability of this chronic conduction aphasia patient and enhanced the cerebral functional and microstructural reorganization.

Neural organization of spoken language revealed by lesion-symptom mapping.

Studies of patients with acquired cognitive deficits following brain damage and studies using contemporary neuroimaging techniques form two distinct streams of research on the neural basis of cognition. In this study, we combine high-quality structural neuroimaging analysis techniques and extensive behavioural assessment of patients with persistent acquired language deficits to study the neural basis of language. Our results reveal two major divisions within the language system-meaning versus form and recognition versus production-and their instantiation in the brain. Phonological form deficits are associated with lesions in peri-Sylvian regions, whereas semantic production and recognition deficits are associated with damage to the left anterior temporal lobe and white matter connectivity with frontal cortex, respectively. These findings provide a novel synthesis of traditional and contemporary views of the cognitive and neural architecture of language processing, emphasizing dual routes for speech processing and convergence of white matter tracts for semantic control and/or integration.

Conduction aphasia with intact visual object naming.

Conduction aphasia, most often caused by damage to the inferior parietal lobe and arcuate fasciculus, is usually characterized by mildly dysfluent speech with frequent phonemic paraphasic errors, impaired repetition, and impaired word finding and naming, but with relatively spared comprehension. We report an 86-year-old right-handed man with conduction aphasia caused by an infarction that damaged his right temporoparietal region. On testing with the Western Aphasia Battery, however, he named objects almost perfectly. To test his naming ability further, we showed him half the items in the Boston Naming Test; we described or defined the other half of the items, but did not show them to the patient. He performed excellently when naming the objects that he could see, but he had difficulty naming the objects that were only described or defined. These observations suggest that visual word naming may be mediated by a network that is somewhat independent of the networks that mediate spontaneous word finding and word finding based on verbal descriptions or definitions.

What can iconic gestures tell us about the language system? A case of conduction aphasia.

BACKGROUND: Speech and language therapists rarely analyse iconic gesture when assessing a client with aphasia, despite a growing body of research suggesting that language and gesture are part of either the same system or two highly integrated systems. This may be because there has been limited research that has systematically analysed iconic gesture production by people with aphasia. AIMS: The aim was to determine whether the gesture production of a participant with conduction aphasia was able to provide information about her language system. METHODS & PROCEDURES: The iconic gestures produced by a participant with conduction aphasia (LT) and five control participants produced during the retelling of a cartoon were analysed. In particular, the iconic gestures produced during lexical retrieval difficulties (co-tip-of-the-tongue (co-TOT) gestures) were compared with the iconic gestures produced during fluent speech (co-speech gestures). OUTCOMES & RESULTS: It was found that LT produced 57 co-speech gestures that were similar in form to the co-speech gestures produced by the control participants (mean = 34.2, standard deviation (SD) = 22.2). LT also produced an additional eleven co-TOT gestures that were unlike her co-speech gestures and unlike the co-speech gestures produced by the control participants. While the co-speech gestures depicted events, the co-TOT gestures depicted 'things' (for example, objects and animals). Furthermore, all but one of the co-TOT gestures produced by LT was classified as a shape-outline gesture, whereas co-speech gestures were rarely classified as shape-outline gestures. LT also produced a new type of gesture that has not previously been described in the literature: a homophone gesture. This co-TOT homophone gesture depicted the homophone of the target word. The iconic gestures produced by LT suggest that she had an intact semantic system but had difficulties with phonological encoding, consistent with a diagnosis of conduction aphasia. This raises the possibility that iconic gesture production can provide evidence about the level of breakdown in the language system. CONCLUSIONS & IMPLICATIONS: A larger study exploring the gestures produced by participants with aphasia is required. The research also highlights the importance of including gesture assessments in SLT's work with adults with acquired language disorder.

Conduction aphasia, sensory-motor integration, and phonological short-term memory - an aggregate analysis of lesion and fMRI data.

Conduction aphasia is a language disorder characterized by frequent speech errors, impaired verbatim repetition, a deficit in phonological short-term memory, and naming difficulties in the presence of otherwise fluent and grammatical speech output. While traditional models of conduction aphasia have typically implicated white matter pathways, recent advances in lesions reconstruction methodology applied to groups of patients have implicated left temporoparietal zones. Parallel work using functional magnetic resonance imaging (fMRI) has pinpointed a region in the posterior most portion of the left planum temporale, area Spt, which is critical for phonological working memory. Here we show that the region of maximal lesion overlap in a sample of 14 patients with conduction aphasia perfectly circumscribes area Spt, as defined in an aggregate fMRI analysis of 105 subjects performing a phonological working memory task. We provide a review of the evidence supporting the idea that Spt is an interface site for the integration of sensory and vocal tract-related motor representations of complex sound sequences, such as speech and music and show how the symptoms of conduction aphasia can be explained by damage to this system.

Atypical conduction aphasia and the right hemisphere: Cross-hemispheric plasticity of phonology in a developmentally dyslexic and dysgraphic patient with early left frontal damage.

We report the rare case of a patient, JNR, with history of mixed handedness, developmental dyslexia, dysgraphia, and attentional deficits associated with a Klippel-Trenaunay syndrome and a small subcortical frontal lesion involving the left arcuate fasciculus. In adulthood, he suffered a large right perisylvian stroke and developed atypical conduction aphasia with deficits in input and output phonological processing and poor auditory-verbal short-term memory. Lexical-semantic processing for single words was intact, but he was unable to access meaning in sentence comprehension and repetition. Reading and writing deficits worsened after the stroke and he presented a combination of developmental and acquired dysgraphia and dyslexia with mixed lexical and phonological processing deficits. This case suggest that a small lesion sustained prenatally or early in life could induce a selective rightward shift of phonology sparing the standard left hemisphere lateralisation of lexical-semantic functions.

Conduction aphasia as an initial symptom in a patient with Creutzfeldt-Jakob disease.

We report a 59-year-old woman who presented to our facility with conduction aphasia as an initial symptom which, within 3months, was followed by generalized myoclonus and global aphasia. She had difficulty repeating words during the Korean-Western Aphasia Battery test. Diffusion-weighted MRI demonstrated ribbon-like hyperintensities in the bilateral temporal, parietal and occipital cerebral cortex. An electroencephalogram showed periodic discharges over the bilateral hemispheres, while single photo emission CT revealed diminished perfusion. After a positive finding of the 14-3-3 protein in her cerebrospinal fluid, she was diagnosed as having probable sporadic Creutzfeldt-Jakob disease.

[Case of conduction aphasia due to right hemispheric lesion].

We report the case of conduction aphasia due to injury of the right hemisphere of the brain. The patient was a right-handed male in his fifties with moyamoya disease. T2-weighted MRI showed an extensive high intensity area in the right temporal-parietal-occipital lobes. In the case of language-related symptoms, comprehension was preserved, but phonemic paraphasias were frequent, and kana paragraphias were also observed. Despite the extensive injury of the right hemisphere, these language-related symptoms were consistent with the clinical features of conduction aphasia. Therefore, this patient was diagnosed with atypical crossed aphasia. Improvement in the phonemic paraphasia differed between words and nonsense words, suggesting that the improvement was dependent on the level of meaning of the words.

Corticobasal degeneration presenting with progressive conduction aphasia.

We report the case of a woman with primary progressive aphasia (PPA) presenting with conduction aphasia. Neurological findings showed bilateral finger tremor and signe de poignet figé in her right hand. Memory, orientation, and activities of daily living were well preserved. Linguistic examination showed severe impairment in repetition, fluent spontaneous speech with phonemic paraphasia, and relatively well preserved comprehension. Limb-kinetic apraxia and parkinsonism were not observed during the course of her illness. T1-weighted magnetic resonance imaging revealed severe atrophy of the left temporal lobe and dilatation of the left Sylvian fissure. Neuropathological findings demonstrated the most severe atrophy in the left superior temporal gyrus and Gallyas-Braak-positive or phosphorylated tau-immunoreactive cytoskeletal structures, which were consistent with corticobasal degeneration (CBD). We speculate that the progressive conduction aphasia of our patient might have been caused by left temporal lobe impairment. We suggest that progressive conduction aphasia may be a feature of CBD presenting with PPA.

Conduction aphasia as a function of the dominant posterior perisylvian cortex. Report of two cases.

Assessment of eloquent functions during brain mapping usually relies on testing reading, speech, and comprehension to uncover transient deficits during electrical stimulation. These tests stem from findings predicted by the Geschwind-Wernicke hypothesis of receptive and expressive cortices connected by white matter tracts. Later work, however, has emphasized cortical mechanisms of language function. The authors report two cases that demonstrate that conduction aphasia is cortically mediated and can be inadequately assessed if not specifically evaluated during brain mapping. To determine the distribution of language on the dominant cortex, electrical cortical stimulation was performed in two cases by using implanted subdural electrodes during brain mapping before epilepsy surgery. A transient isolated deficit in repetition of language was reported during stimulation of the posterior portion of the dominant superior temporal gyrus in one patient and during stimulation of the supramarginal gyrus in the other patient. These cases demonstrate a localization of language repetition to the posterior perisylvian cortex. Brain mapping of this region should include assessment of verbal repetition to avoid potential deficits resembling conduction aphasia.

Linguistic and neuropsychological deficits in crossed conduction aphasia. Report of three cases.

This study describes the linguistic and neuropsychological findings in three right-handed patients with crossed conduction aphasia. Despite the location of the lesion in the right hemisphere, all patients displayed a combination of linguistic deficits typically found in conduction aphasia following analogous damage to the left hemisphere. Associated cognitive deficits varied across the three patients. In addition, all cases showed deficits classically attributed to non-dominant hemisphere damage (visuoperceptual deficits and reduced figural memory). As a result, lesion-behaviour relationships in our study sample indicate both dominant and non-dominant qualities of the right hemisphere.

Neuroanatomical correlates of the post-stroke aphasias studied with cerebral blood flow SPECT scanning.

BACKGROUND: Researchers are not in complete agreement over the extent to which specific language functions are subserved by certain brain areas. The purpose of this article was to determine neuroanatomical correlates of aphasia following cerebrovascular accident. MATERIAL/METHODS: The participants included 50 stroke patients with a single left-hemisphere lesion and residual mild to severe aphasia. Language, assessed by the Boston Diagnostic Aphasia Examination (BDAE), was affected to various degrees by a wide range of pathologies. Single-photon emission computed tomography (SPECT) images of the brain were acquired with 740 MBq (20 mCi) of Tc-99m-labeled ECD on a triple-headed gamma camera equipped with low-energy, high-resolution collimator. Correlation between reduced cerebral perfusion and the BDAE score was analyzed. RESULTS: The most prominent perfusion abnormalities in Broca's aphasia, as determined by the laterality index, were found in the frontal lobe, and to a lesser degree, the parietal lobe and striatum, whereas the most prominent deficits in Wernicke's aphasia were found in the left temporal and parietal areas. In global aphasia, SPECT images evidenced the most extensive damage throughout the perisylvian region of the left hemisphere. CONCLUSIONS: There is need for reinterpretation of the anatomical correlation of selected aphasic syndromes, especially classic Broca's and Wernicke's aphasias. The present study highlights the integrative role of some subcortical structures in language and speech functions. The results support the usefulness of regional cerebral blood flow SPECT imaging as a diagnostic aid in the post-stroke aphasias.

[A case of conduction aphasia due to small infarction in the left parietal lobe].

This is a report on the patient with conduction aphAsia due to small infarction in the left parietal lobe. The patient is a right-handed man aged 74, who developed a speech disorder and mild paralysis of the right hand on November 13. 1996. A CT scan showed a small low-density in the supramarginal gyrus of the left parietal lobe. Standard Language Test of aphasia (SLTA) conducted at five days after admission to the hospital showed preserved auditory comprehension and phonemic para-aphasia symptoms with respect to volitional speech, naming, reading aloud and repetition. Frequent self-correction was also observed while repetition was not remarkably impaired. A test at three months after the onset revealed generally fluent speech, while there still remained occasional phonemic para-aphasia and self-correction for the speech disruption. Three years and four months later, most of the aphasic syndromes disappeared, although the patient claimed he still had difficulty in speaking. This case suggests that conduction aphasia can be caused by a lesion, though small, located in arcuate fibers of the cerebrum. The characteristics are phonemic para-aphasia with respect to general speech functions as well as self-correction toward target words. The indicated that lesions in the pathway connecting Broca's area and Wernicke's area causes difficulties in selecting accurate phonemes due to a malfunctioning interface between the two areas.

Primary progressive aphasia presenting as conduction aphasia.

We report a case of a woman with primary progressive aphasia (PPA) who presented with conduction aphasia. A 60-year-old, right-handed, Japanese female suffering from progressive aphasia had difficulty in repeating words and phrases. She displayed phonemic paraphasias but had preserved comprehension and had no cognitive or behavior disorder for more than 6 years after the onset of the condition. She was able to continue to work successfully and to perform all her normal daily activities. T1-weighted magnetic resonance imaging revealed minute dilatation of the left inferior horn and sulci in the left hemisphere, and positron emission tomography revealed mild hypometabolism in the left supramarginal gyrus and its surrounding areas. Therefore, she was diagnosed as suffering from PPA presenting as conduction aphasia. We believe that the progressive conduction aphasia of the patient belongs to one of the fluent forms of PPA, and the ability to continue normal work along with the clinical portrayal of preserved memory and cognition skills may be features of a form of PPA presenting as conduction aphasia.