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Journal of Speech, Language, and... Apr 2010Damage to left perisylvian cortex often results in impaired phonological processing abilities with written language profiles consistent with phonological alexia and...
PURPOSE
Damage to left perisylvian cortex often results in impaired phonological processing abilities with written language profiles consistent with phonological alexia and phonological agraphia. The purpose of this article was to examine a behavioral treatment sequence for such individuals intended to strengthen phonological processing and links between phonology and orthography, as well as train a means to maximize use of residual orthographic and phonological knowledge for spelling.
METHOD
Two women with persistent impairments of written language and phonological processing following damage to left perisylvian cortical regions participated in this study. Both exhibited characteristic features of phonological alexia and agraphia in that reading and spelling performance for real words was better preserved than nonwords (lexicality effect). A 2-stage treatment protocol was administered to strengthen sublexical skills (phonological treatment) and to train interactive use of lexical and sublexical information to maximize spelling performance (interactive treatment).
RESULTS
Both participants improved phonological processing abilities and reading/spelling via the sublexical route. They also improved spelling of real words and were able to detect and correct most residual errors using an electronic spelling aid.
CONCLUSIONS
Behavioral treatment served to strengthen phonological skills supporting reading and spelling, and provided a functional compensatory strategy to overcome residual weaknesses.
Topics: Adult; Aged; Agraphia; Cerebral Cortex; Dyslexia; Female; Functional Laterality; Humans; Infarction, Middle Cerebral Artery; Language Tests; Language Therapy; Phonetics; Reading; Time Factors; Treatment Outcome; Writing
PubMed: 20360466
DOI: 10.1044/1092-4388(2009/08-0229) -
Journal of Neurology, Neurosurgery, and... Mar 2002It remains unclear from lesion studies whether the four signs of the Gerstmann syndrome (finger agnosia, acalculia, agraphia, and right-left confusion) cluster because...
BACKGROUND
It remains unclear from lesion studies whether the four signs of the Gerstmann syndrome (finger agnosia, acalculia, agraphia, and right-left confusion) cluster because the neuronal nets that mediate these activities have anatomical proximity, or because these four functions share a common network. If there is a common network, with degeneration, as may occur in Alzheimer's disease, each of the signs associated with Gerstmann's syndrome should correlate with the other three signs more closely than they correlate with other cognitive deficits.
METHODS
Thirty eight patients with probable Alzheimer's disease were included in a retrospective analysis of neuropsychological functions.
RESULTS
The four Gerstmann's syndrome signs did not cluster together. Finger naming and calculations were not significantly correlated. Right-left knowledge and calculations also did not correlate.
CONCLUSIONS
The four cognitive functions impaired in Gerstmann's syndrome do not share a common neuronal network, and their co-occurrence with dominant parietal lobe injuries may be related to the anatomical proximity of the different networks mediating these functions.
Topics: Adult; Aged; Alzheimer Disease; Anomia; Diagnosis, Differential; Dominance, Cerebral; Female; Gerstmann Syndrome; Humans; Male; Middle Aged; Nerve Net; Neuropsychological Tests; Parietal Lobe; Problem Solving
PubMed: 11861708
DOI: 10.1136/jnnp.72.3.403 -
Cureus Jun 2021Gerstmann syndrome is a neurobehavioral syndrome characterized by four cardinal symptoms: acalculia, agraphia, finger-toe agnosia, and dysgraphia. The syndrome is caused...
Gerstmann syndrome is a neurobehavioral syndrome characterized by four cardinal symptoms: acalculia, agraphia, finger-toe agnosia, and dysgraphia. The syndrome is caused primarily by lesions at the confluence of parietal, temporal, and occipital lobes, but also can involve the middle frontal lobe of the dominant hemisphere. Documented inciting lesions include stroke, tumor, hemorrhage, arteriovenous malformations, and seizures. A meningeal solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is a diagnostic challenge due to its resemblance to more common brain tumors like meningioma, with histopathology being the definitive diagnostic test. A 37-year-old male presented to our tertiary center with blurred vision, "not being himself," and "acting funny" for three weeks. On exam, he was found to have a right inferior quadrantanopia, grade II papilledema and demonstrated all four symptoms of Gerstmann syndrome - inability to perform simple calculations (acalculia), or identify his fingers (finger agnosia), could not distinguish his left side from the right (left-right disorientation), nor write out his name (agraphia). Brain imaging showed an extra-axial, highly vascularized 7.6-cm mass compressing the left parietal lobe. He underwent a complete resection of the mass. Postoperatively, he had gradual improvement with complete resolution of agraphia, acalculia, finger agnosia, and left-right disorientation within a week status post-resection. Tumor pathology indicated hemangiopericytoma/solitary fibrous tumor. This case enunciates the enigmatic tetrad of Gerstmann syndrome. Though classically described as a sequela of stroke, the mass effect of the tumor on the parietal lobe may produce the symptoms, which can resolve following resection.
PubMed: 34327089
DOI: 10.7759/cureus.15863 -
BMC Neurology Nov 2021Neurological manifestations of coronavirus disease 2019 (COVID-19) are increasingly recognized and include encephalopathy, although direct infection of the brain by...
BACKGROUND
Neurological manifestations of coronavirus disease 2019 (COVID-19) are increasingly recognized and include encephalopathy, although direct infection of the brain by SARS-CoV-2 remains controversial. We herein report the clinical course and cytokine profiles of a patient with severe SARS-CoV-2-related encephalopathy presenting aphasia.
CASE PRESENTATION
An 81-year-old man developed acute consciousness disturbance and status epileptics several days after SARS-CoV-2 infection. Following treatment with remdesivir and dexamethasone, his consciousness and epileptic seizures improved; however, amnestic aphasia and agraphia remained. Two months after methylprednisolone pulse and intravenous immunoglobulin, his neurological deficits improved. We found increased levels of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1), but not IL-2 and IL-10 in the serum and cerebrospinal fluid (CSF), and the levels of serum IL-6 and MCP-1 were much higher than those in the CSF. The level of IL-8 in the CSF after immunotherapy was four times higher than that before immunotherapy.
CONCLUSION
The cytokine profile of our patient was similar to that seen in severe SARS-CoV-2-related encephalopathy. We demonstrated (i) that the characteristic aphasia can occur as a focal neurological deficit associated with SARS-CoV-2-related encephalopathy, and (ii) that IL8-mediated central nervous system inflammation follows systemic inflammation in SARS-CoV-2-related encephalopathy and can persist and worsen even after immunotherapy. Monitoring IL-8 in CSF, and long-term corticosteroids may be required for treating SARS-CoV-2-related encephalopathy.
Topics: Aged, 80 and over; Aphasia; Brain Diseases; COVID-19; Humans; Interleukin-8; Male; SARS-CoV-2
PubMed: 34727881
DOI: 10.1186/s12883-021-02459-3 -
Journal of Postgraduate Medicine 2021Agraphia is defined as the disruption of the previously intact writing skills due to an acquired brain damage. Stroke remains the most common cause of language...
Agraphia is defined as the disruption of the previously intact writing skills due to an acquired brain damage. Stroke remains the most common cause of language impairment; however, writing disorders, including agraphia, are underestimated in patients with stroke. In this regard, we report two patients presenting with pure agraphia as an early symptom of stroke. Both patients complained of at least two difficulties in visualizing letter formation beforehand, the frequent need for verbal cues, misuse of lines and margins, poorly legible signature, and writing and thinking at the same time (e.g., creative thinking and taking notes). They underwent brain magnetic resonance imaging which revealed a small lacunar infarction of the left insula and external capsule (patient 1) and a small hemorrhagic lesion in the posterior limb of the left internal capsule (patient 2). To our knowledge, this is the first report on pure agraphia as the presenting symptom of stroke. We suggest that all patients with acute agraphia, even when presenting as an isolated symptom, should be evaluated for stroke, in order to better facilitate its diagnosis and treatment.
Topics: Agraphia; Brain; External Capsule; Humans; Internal Capsule; Magnetic Resonance Imaging; Male; Middle Aged; Stroke; Stroke, Lacunar
PubMed: 33835058
DOI: 10.4103/jpgm.JPGM_1066_20 -
PloS One 2016Patients with Parkinson's disease (PD) and freezing of gait (FOG) suffer from more impaired motor and cognitive functioning than their non-freezing counterparts. This... (Comparative Study)
Comparative Study
BACKGROUND
Patients with Parkinson's disease (PD) and freezing of gait (FOG) suffer from more impaired motor and cognitive functioning than their non-freezing counterparts. This underlies an even higher need for targeted rehabilitation programs in this group. However, so far it is unclear whether FOG affects the ability for consolidation and generalization of motor learning and thus the efficacy of rehabilitation.
OBJECTIVE
To investigate the hallmarks of motor learning in people with FOG compared to those without by comparing the effects of an intensive motor learning program to improve handwriting.
METHODS
Thirty five patients with PD, including 19 without and 16 with FOG received six weeks of handwriting training consisting of exercises provided on paper and on a touch-sensitive writing tablet. Writing training was based on single- and dual-task writing and was supported by means of visual target zones. To investigate automatization, generalization and retention of learning, writing performance was assessed before and after training in the presence and absence of cues and dual tasking and after a six-week retention period. Writing amplitude was measured as primary outcome measure and variability of writing and dual-task accuracy as secondary outcomes.
RESULTS
Significant learning effects were present on all outcome measures in both groups, both for writing under single- and dual-task conditions. However, the gains in writing amplitude were not retained after a retention period of six weeks without training in the patient group without FOG. Furthermore, patients with FOG were highly dependent on the visual target zones, reflecting reduced generalization of learning in this group.
CONCLUSIONS
Although short-term learning effects were present in both groups, generalization and retention of motor learning were specifically impaired in patients with PD and FOG. The results of this study underscore the importance of individualized rehabilitation protocols.
Topics: Aged; Agraphia; Auditory Perception; Biomechanical Phenomena; Cues; Female; Gait Disorders, Neurologic; Hand; Humans; Learning Disabilities; Male; Memory Disorders; Middle Aged; Motor Skills; Parietal Lobe; Parkinson Disease; Psychomotor Performance; Retention, Psychology; Writing
PubMed: 26862915
DOI: 10.1371/journal.pone.0148933 -
Behavioural Neurology 1994We report a patient who developed selective Kana (phonogram) agraphia following an infarct in the left middle frontal gyrus known as Exner's area. He had well-preserved...
We report a patient who developed selective Kana (phonogram) agraphia following an infarct in the left middle frontal gyrus known as Exner's area. He had well-preserved ability for comprehension, reading, and writing Kanji (ideogram). Kana errors consisted of substitution with another letter while the number of target words was well preserved. It is suggested that a dominant middle frontal gyrus lesion can result in agraphia.
PubMed: 24487291
DOI: 10.3233/BEN-1994-7205 -
Neuropsychologia Jun 2007Coltheart and co-workers [Castles, A., Bates, T. C., & Coltheart, M. (2006). John Marshall and the developmental dyslexias. Aphasiology, 20, 871-892; Coltheart, M.,...
Coltheart and co-workers [Castles, A., Bates, T. C., & Coltheart, M. (2006). John Marshall and the developmental dyslexias. Aphasiology, 20, 871-892; Coltheart, M., Rastle, K., Perry, C., Langdon, R., & Ziegler, J. (2001). DRC: A dual route cascaded model of visual word recognition and reading aloud. Psychological Review, 108, 204-256] have demonstrated that an equation derived from dual-route theory accurately predicts reading performance in young normal readers and in children with reading impairment due to developmental dyslexia or stroke. In this paper, we present evidence that the dual-route equation and a related multiple regression model also accurately predict both reading and spelling performance in adult neurological patients with acquired alexia and agraphia. These findings provide empirical support for dual-route theories of written language processing.
Topics: Adult; Age Factors; Aged; Agraphia; Algorithms; Atrophy; Brain Ischemia; Cerebral Cortex; Dyslexia, Acquired; Functional Laterality; Humans; Middle Aged; Models, Neurological; Neural Pathways; Reading; Stroke
PubMed: 17482218
DOI: 10.1016/j.neuropsychologia.2007.03.019 -
Brain & NeuroRehabilitation Mar 2023Gerstmann syndrome (GS) is a rare syndrome that occurs when there is a lesion of the dominant inferior parietal lobule (IPL), causing agraphia, acalculia, finger...
Gerstmann syndrome (GS) is a rare syndrome that occurs when there is a lesion of the dominant inferior parietal lobule (IPL), causing agraphia, acalculia, finger agnosia, and right-left disorientation. A 49-year-old right-handed male was diagnosed as GS after left parieto-occipital lobe hemorrhage. The patient showed mild anomic aphasia with agraphia in the language test and the neuropsychological test revealed acalculia, impaired right-left discrimination, and finger agnosia. In diffusion tensor tractography, the tracts of left superior longitudinal fasciculus (SLF), middle longitudinal fasciculus, U-fibers and posterior corpus callosum (CC) were disrupted around the left IPL. In addition, fractional anisotropy (FA) values were markedly decreased in left SLF, and posterior CC when compared to twelve healthy control subjects. Our clinical and neuroimaging findings support that GS is a disconnection syndrome caused by lesion in the white matter pathway surrounding IPL. In future, more studies of the correlation between the white matter disconnection and the development of GS including high quality imaging technique are needed.
PubMed: 37033002
DOI: 10.12786/bn.2023.16.e3 -
Neuropsychiatric Disease and Treatment 2017A 60-year-old female was treated for depression with the antidepressant paroxetine for 13 years. The patient had experienced clumsiness and mild rigidity in the left...
A 60-year-old female was treated for depression with the antidepressant paroxetine for 13 years. The patient had experienced clumsiness and mild rigidity in the left hand, and had agraphia and mild subjective memory complaints for 3 years prior to admission in our hospital. She experienced exacerbated depression that included worsened depressive mood, lowered motivation, and suicidal ideation without precipitating stressful life events for 2 years prior to admission, and although she had continued taking the antidepressant, these symptoms were not ameliorated by increasing the dose of paroxetine. Following the development of myoclonus and pain in her left arm, we performed magnetic resonance imaging of her head, that revealed diffuse atrophy and right parietal lobe atrophy. The patient was ultimately diagnosed with corticobasal degeneration (CBD). Her left arm myoclonus and depression improved following levodopa administration. Therefore, we concluded that the recurrent depression may have been induced by CBD.
PubMed: 28458551
DOI: 10.2147/NDT.S136706