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Neurology in Documentaries
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
Aphasia may improve up to 6 months after a stroke, after which it reaches a plateau. Semantics and syntax may improve considerably up to 6 weeks; phonology and token test (measuring severity of the aphasias) may improve up to 3 months. In patients with global aphasia, speech output may improve, but verbal communication lags behind.
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
Thornas and Dale’s definition of central aphasia as one which affects all aspects of language about equally sounds possibly equivalent to the usual definition of global aphasia. Further comparison reveals, however, that the two terms do differ in meaning. Global aphasia usually implies not only that all aspects of language are affected about equally, but also that they are affected severely (e.g., A&V, p. 358; DeJ, p. 656–657). In contrast, Thornas and Dale describe some patients with central aphasia in whorn the language impairments are “mild” and others in whorn the impairments are “moderate,” as well as some with “severe” language impairments (1981, p. 233).
Recognising and engaging with language problems
Published in Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster, Addressing Brain Injury in Under-Resourced Settings, 2017
Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster
Global aphasia typically occurs as a result of a large area of damage to the left side of the brain, including Wernicke’s area and Broca’s area. It is often seen very soon after a large stoke, and then usually changes into another type of aphasia over time, as improvement occurs.
Assessment and management of cytokine release syndrome and neurotoxicity following CD19 CAR-T cell therapy
Published in Expert Opinion on Biological Therapy, 2020
Cassie K. Chou, Cameron J. Turtle
Neurotoxicity typically presents after the onset of CRS, and often after its resolution. Infrequently, it can occur in the absence of prior CRS. The median time to onset of neurotoxicity ranges from 4 to 10 days following CAR-T cell infusion, but the incidence (Table 1), kinetics, and clinical findings may differ between those receiving different CAR-T cell products. Most neurotoxicity is mild and self-limited; symptoms can include headache, lethargy, impaired attention, dysgraphia, apraxia, aphasia, agitation, tremor, encephalopathy, and seizures [2,7,11,27,28,32,48,49]. Dysfunction of higher centers, such as dysgraphia and dyscalculia are often early findings that are detected by objective evaluation tools [27]. Speech disorders are characteristic and can progress to global aphasia in more severe cases [32]. Electroencephalography (EEG) done in encephalopathic patients typically shows background slowing suggesting diffuse encephalopathy [32,49,50]. Cerebral hemorrhage and diffuse cerebral edema have been reported as manifestations of severe neurotoxicity, but appear to be uncommon [45,49,51,52]. Most patients with neurotoxicity do not have new imaging changes on CT or MRI [8,32,53]. However, when abnormal imaging findings are present, they may be associated with a higher risk of a poor outcome [53]. Multiple patterns of abnormal MRI imaging of the brain have been reported in patients with severe neurotoxicity, including white matter changes, cytotoxic edema, microhemorrhages, and/or diffuse leptomeningeal enhancement (Figure 1) [32,49].
The role of music therapy in rehabilitation: improving aphasia and beyond
Published in International Journal of Neuroscience, 2018
Simona Leonardi, Alberto Cacciola, Rosaria De Luca, Bianca Aragona, Veronica Andronaco, Demetrio Milardi, Placido Bramanti, Rocco Salvatore Calabrò
The most common varieties of aphasia are the fluent and non-fluent forms; the former is characterized by the inability to understand the meaning of written and spoken words, resulting in a severe impairment in reading and writing [70]. In non-fluent aphasia, instead, patients are able to read and understand speech relatively well, although writing, vocabulary access and formation of sound may be limited. Indeed, severe decrease of speech output, agrammatism and apraxia of speech represent main features of this form of aphasia, playing a major role as clinical markers to differentiate non-fluent aphasia from other forms of aphasia [70,71]. On the other hand, patients with global aphasia are neither able to understand spoken language nor able to read, write, repeat words or name objects [70].
Diagnosing and managing post-stroke aphasia
Published in Expert Review of Neurotherapeutics, 2021
Shannon M. Sheppard, Rajani Sebastian
Global aphasia is the most severe subtype of aphasia, as patients experience difficulties with all aspects of language. However, other modalities like facial expressions and gestures can be used to communicate basic needs or feelings [18]. Comprehension is significantly impaired even at the single word level, and spoken output is severely limited. Spontaneous speech, naming, and repetition are often constrained to recurring utterances (e.g., ‘nuh, nuh, nuh’; parts of speech ‘I want to,’ etc.). Global aphasia is associated with large left hemisphere lesions affecting Broca’s area and Wernicke’s area [14,19].