Confusion vs Broca Aphasia: A Case Report.

INTRODUCTION: Broca aphasia presents with impaired expression of spoken and/or written language and is often caused by infarction in the Broca area in the frontal lobe. We present a case of Broca aphasia that was initially interpreted as confusion. CASE PRESENTATION: A 76-year-old woman was brought to the Emergency Department because of confusion and slurred speech that began in the morning. The patient had an extensive history of alcohol abuse, hyperlipidemia, and hypertension and had recently quit drinking 5 days earlier. The patient appeared confused, answering questions with "I don't know," but had no signs of agitation. Magnetic resonance imaging of the brain confirmed a recent infarct involving the left frontal and occipital lobes, coinciding with the Broca area. The patient was able to communicate via writing and eventually made an uneventful recovery of speech. DISCUSSION: This case demonstrates a patient without the display of stereotypical signs of stroke, yet that was the underlying condition leading to her aphasia. It is important for clinicians to be aware that a stroke can present with isolated findings such as language deficit or confusion.

Malignant atrophic papulosis with motor aphasia and intestinal perforation: A case report and review of published works.

Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.

[Clinical research of post-stroke motor aphasia treated with acupoint application of jieyu plaster combined with acupuncture].

OBJECTIVE: To compare the difference in clinical efficacy on post-stroke motor aphasia among the combined therapy of acupoint application of jieyu plaster and acupuncture, simple acupuncture and simple acupoint application of jieyu plaster. METHODS: Eighty-six patients of post-stroke motor aphasia were randomized into an acupuncture group (28 cases) , an acupoint application gruop (29 cases) and the combined therapy group (29 cases). In the acupuncture group, acupuncture was applied at the Speech No. 1 area and three-tongue needling points, once a day, 6 times a week. In the acupoint application group, jieyue plaster was applied to Yongquan (KI 1) and Laogong (PC 8), once a day, and the bilateral acupoints were selected alternatively. In the combined therapy group, the therapeutic methods of the first two groups were used in combination. The treatment lasted for 4 weeks in the three groups. The speech function score was observed and compared before and after treatment in the three groups and the efficacy was compared among the three groups. RESULTS: The total effective rate was 86.2% (25/29) in the combined therapy group, which was better than 67.9% (19/28) in the acupuncture group and 69.0% (20/29) in the acupoint application group (both P < 0.05). After treatment, the scores of spontaneous conversation, restatement and nomenclature in the speech function were all improved as compared with those before treatment in the three groups (all P < 0.01). The results in the combined therapy group were apparently better than those in the acupuncture group and the acupoint application group (all P < 0.01). CONCLUSION: The combined therapy of acupoint application of jieyu plaster and acupuncture apparently improves the speech function in the treatment of post-stroke motor aphasia and the efficacy is better than that of simple acupuncture or simple acupoint application.

Cerebrolysin adjuvant treatment in Broca's aphasics following first acute ischemic stroke of the left middle cerebral artery.

BACKGROUND: The aim of our study was to assess the efficacy of Cerebrolysin administration in Broca's aphasics with acute ischemic stroke. METHODS: We registered 2212 consecutive Broca's aphasics following an acute ischemic stroke admitted in four departments of neurology in Romania, between September 2005 and September 2009. Language was evaluated with the Romanian version of the Western Aphasia Battery (WAB). The following inclusion criteria were used for this study: age 20-75 years, admission in the hospital within 12 hours from the onset of the symptoms, diagnosis of first acute left middle cerebral artery (MCA) ischemic stroke, presence of large artery disease (LAD) stroke, a NIHSS score of 5-22 points, and a therapeutic time window within 72 h. Fifty two patients were treated with Cerebrolysin (Cerebrolysin group) as an adjunctive treatment. A placebo group, which received saline infusions (n=104 patients) were matched to the NIHSS and WAB scores, gender and age of the Cerebrolysin group at baseline. We assessed spontaneous speech (SS), comprehension (C), repetition (R), naming (N), and Aphasia Quotient (AQ) scores of the two groups in an open label design, over 90 days, the mRS scores and mortality. RESULTS: The Cerebrolysin and the placebo groups had similar age (66 +/- 8 versus 65 +/- 8 years) and sex ratio (14/38 versus 30/74). The mean AQ scores and the mean subscores for 3 subtests of WAB (SS, R, N) were similar at baseline and improved in the Cerebrolysin group significantly (p < 0.05) over placebo group at all study time points. The mRS score at 90 days was also lower in the Cerebrolysin group than in the placebo group. Cerebrolysin and placebo were both tolerated and safe, and no difference in the mortality rate was seen (3.8% in each group). CONCLUSION: Cerebrolysin is effective for the treatment of Broca's aphasics with a first acute ischemic stroke of the left MCA territory.

Effect of propranolol on naming in chronic Broca's aphasia with anomia.

Previous research suggests that the noradrenergic system modulates flexibility of access to the lexical-semantic network, with propranolol benefiting normal subjects in lexical-semantic problem solving tasks. Patients with Broca's aphasia with anomia have impaired ability to access appropriate verbal output for a given visual stimulus in a naming task. Therefore, we tested naming in a pilot study of chronic Broca's aphasia patients with anomia after propranolol and after placebo in a double-blinded crossover manner. Naming was better after propranolol than after placebo, suggesting a potential benefit from propranolol in chronic Broca's aphasia with anomia. Larger follow-up studies are necessary to further investigate this effect.

Amantadine for adynamic speech: possible benefit for aphasia?

OBJECTIVE: Dopaminergic agents may stimulate behavior and verbal expression after frontal lobe dysfunction. Although amantadine is used in neurorehabilitation of motivational disorders and head injury, it is not commonly prescribed to improve aphasia. This pilot study examined verbal fluency on and off amantadine for nonfluent speech. DESIGN: Four participants undergoing inpatient rehabilitation, meeting criteria for transcortical motor aphasia had stroke (2), stroke postaneurysm surgery (1), or brain tumor resection (1). We administered 100 mg of amantadine twice a day in an open-label, on-off protocol, with multiple assessments per on-off period. RESULTS: Off medication, subjects generated a mean 12.62 of words (abnormally few) on the Controlled Oral Word Association test. On medication, word generation significantly improved to 17.71 words (P = 0.04), although scores remained psychometrically in the abnormal range. CONCLUSIONS: Further research on amantadine, specifically for nonfluent speech and nonfluent aphasia, including effects on functional communication and control conditions, may be warranted.

A randomized, double-blind trial of bromocriptine efficacy in nonfluent aphasia after stroke.

The authors assessed the efficacy of bromocriptine in nonfluent aphasia after stroke in a 16-week, randomized, double-blind, placebo-controlled clinical trial conducted from June 2002 to April 2004. In all 38 patients after 4 months of treatment, improvement in both the bromocriptine and placebo treatment groups was observed (p < 0.001). The analysis of repeated-measures analysis of variance revealed bromocriptine did not improve nonfluent aphasia.

West Nile virus meningoencephalitis complicated by motor aphasia in Hodgkin's lymphoma.

A 4 year old boy with Hodgkin's lymphoma was admitted to the paediatric ward with meningoencephalitis dominated by generalised seizures and motor aphasia. Serum IgM specific antibodies to West Nile virus were positive. In view of ongoing neurological deterioration and immunocompromised state he was treated with oral ribavirin for 14 days. A gradual improvement was noted within two weeks of therapy initiation, and with intensive supportive care he recovered completely after four months.

An open-label trial of bromocriptine in nonfluent aphasia: a qualitative analysis of word storage and retrieval.

Anomia is a commonly found in aphasia and has been attributed to a loss of representations (storage deficit) or to a loss of access to these representations (retrieval deficit). Bromocriptine, a dopamine agonist, was tested on four patients, two men and two women, with nonfluent aphasia. The patients were tested in an open-label ABBA design using a stochastic model that measured the degree of storage and retrieval deficits. All patients showed significant improvements in word retrieval. Bromocriptine may be a useful adjunct in the treatment of selected patients with a nonfluent aphasia in which retrieval deficits play a major role.

Acute aphasia in multiple sclerosis.

Acute aphasia is rare in multiple sclerosis. We describe 3 patients with multiple sclerosis who had acute exacerbations presenting as aphasias. One patient had a mixed transcortical aphasia, 1 had a transcortical motor aphasia, and 1 had a Broca aphasia. Magnetic resonance imaging scans of the brain with contrast enhancement revealed new white matter lesions in the left hemisphere in all 3 patients. Two of the 3 patients had a good response to treatment with methylprednisolone sodium succinate. Arch Neurol. 2000;57:1207-1209

Bromocriptine treatment of nonfluent aphasia.

Using a double-blind, placebo-controlled, crossover design, we studied the effect of bromocriptine (15 mg daily) in 20 men with chronic nonfluent aphasia. The study was conducted over a 28-week period in two phases. In phase I, the patients received either bromocriptine or placebo; in phase II the treatments were crossed over. We evaluated each patient's language and nonverbal cognitive skills at the beginning and end of each phase and 6 weeks after completion of phase II. When compared with placebo treatment, bromocriptine did not significantly improve the patient's speech fluency, language content, overall degree of aphasia severity, or nonverbal cognitive abilities. Based on these results, bromocriptine is not recommended as monotherapy for the treatment of chronic nonfluent aphasia.

A randomized, double-blind, placebo-controlled study of bromocriptine in nonfluent aphasia.

We carried out a double-blind and placebo-controlled study of the efficacy of bromocriptine in the treatment of nonfluent aphasia. Seven patients received bromocriptine (up to 60 mg/d) and an identical placebo in a randomized order. End points were the number of content words, content units, and pauses > 3 seconds during the description of a figure; verbal naming; and verbal fluency. There were no significant benefits of bromocriptine over placebo in any of the variables examined.

Bromocriptine is ineffective in the treatment of chronic nonfluent aphasia.

The effect of bromocriptine on chronic nonfluent aphasia was investigated in 4 patients suffering from a stroke 24 to 35 months before the onset of this study (average 29 months). Two patients had Broca, one had global and the other transcortical motor aphasia. CT-scans demonstrated anterior-posterior infarctions in 3 patients and anterior infarction in one. Bromocriptine was given initially at a dosage of 10 mg/day, and of 25 mg/day during the follow ups. By means of aphasia tests, bromocriptine was found to be ineffective for the treatment of any symptoms of chronic nonfluent aphasia.

Rapid resolution following chemotherapy of Broca's dysphasia due to recurrent anaplastic astrocytoma.

A middle-aged man re-presented with a Broca's aphasia due to a recurrent fronto-cingulate anaplastic astrocytoma. Although the language disturbance did not improve with dexamethasone therapy, within 4 weeks of treatment with procarbazine, CCNU and vincristine, the dysphasia had almost completely resolved. The anatomico-functional aspects and possible mechanisms of production and resolution of the aphasia are discussed. Assessment of dysphasias in patients undergoing intensive therapy for brain neoplasms is often neglected, but it can provide good objective information about the efficacy of therapy.