The Modified Stroop Test (MST) and Word Fluency Test (WFT) using initial letters and categories were administered to 21 patients with frontal lesions, 32 patients with non-frontal lesions and 24 normal controls. Patients with aphasia were excluded. In the WFT using initial letters, the frontal group showed significantly lower results than the non-frontal group.
    In order to assess the degree of aspontaneity, we adopted the time which is required for MST ( Part I ) as used to evaluate simple reading fluency. Using the median time of Part I , frontally damaged patients were classified into one group with severe aspontaneity and another with mild aspontaneity. In the latter group, we found a significant negative correlation between performance on WFT using initial letters and disinhibition of stereotypes in the MST, corresponding to the time lag between Part III and Part I . These results suggest that disinhibition of stereotypes plays an important role in the poor performance on the WFT in the frontal group with mild aspontaneity.

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    We report the case of a 51 year-old ambidextrous male who, following diffuse infarction of the right cerebral hemisphere, presented with agrammatism, with notable telegraphic speech. The telegraphic speech was particularly severe during free conversation, but mild during free writing and mild during speech and writing of an explanatory nature (writing or speaking about a given stimulus drawing).
    In all four conditions of verbal testing, function words were often either omitted or substituted. Writing was rapid and fluent, but nearly illegible, and there were substitutions some of the kana (the Japanese syllabograms) and difficulties in remembering the kanji (the Japanese morphograms).
    It is thought that these symptoms emerged due to the right hemispheric damage and an unusual lateralization of language functions in this ambidextrous subject.

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    A case of global aphasia with recurring utterances (RUs) was reported. The clinical course was unique in that real word RUs (RWRUs) evolved to non-meaningful RUs (NMRUs).
    A 73-year-old right handed woman awoke with numbness in her right extremities and with difficulty in speaking. On admission, one day after onset, she was drowsy and had right hemiplegia. Her conciousness became alert on the 6 th hospital day, but she was unable to pronounce any intelligible words. She could not follow simple commands, repeat single words, read aloud or write her name. About 10 days after onset, she began to utter " anta " ( = you) when attempting to speak. Other utterances were not observed except for one or two unintelligible phonemes. About 50 days after onset, her RU changed from RWRU to NMRU. In the transition period, several forms of NMRU were observed, such as " tsuta : n " " ta-ta-ta " " tsu-tsu-tsu " " tsu-ta-ta-ta " , but they soon gave way to " tantan " or " tanta : n " . CT and MR imaging showed a large infarct involving left basal ganglia, corona radiata and parietooccipital lobes but sparing Broca and Wernicke areas. Single photon emission computed tomography, however, demonstrated low RI uptake in the whole left hemisphere.
    Evolution from RWRU to NMRU observed in our case could be explained by the assumption that severely damaged phonological system of the left hemisphere modified RWRU of right hemisphere origin.

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    The aim of this study was to verify the hypothesis advanced by Hécaen and Assal (1970) and Warrington et al. (1966) that constructive disorders of left brain-damaged patients may be due to a planning disorder, while those of right brain-damaged patients may be due to visualspatial disturbances.
    Twenty-one severe apraxic patients (8 with left-sided posterior lesions and 13 with right-sided posterior lesions) were given two tests involving copying of drawings. In the first task, the patients were asked to copy a drawing of a cube directly. In the second task, they were asked to draw on the cube's perimeter gradually, in accordance with a demonstration by an examiner.
    The performances of all the apraxics due to left lesions were improved markedly in the latter test, where no organization plan for performing the task was required, although they did not score at a normal level. By contrast, in the group with right-sided lesions we found that 7 patients out of 13 also improved but not to the same remarkable extent ; in 2 cases no amelioration was observed and in the other 4 cases performances were inferior to the results obtained in the first task.
    These results suggest that visual-spatial disturbances may underlie the constructive disabilities of patients with right-sided lesions, whereas both planning and visual-spatial disorders could be responsible for constructive disturbances shown by patients with left-sided lesions.

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    Six chronic aphasic patients were treated using a method known as PACE, or “Promoting Aphasics Communicative Effectiveness ” . Three patients showed higher scores with PACE after treatment ; three patients shortened initial response time and five patients reduced communication time significantly. Moreover, all six patients demonstrated improved communication ability in daily hospital life. It was concluded from these results that PACE can be effective in improving daily hospital communication. In contrast to conventional stimulus therapy which acts on the impairment level of aphasia, PACE works mainly on the disability level. For this reason we believe that it is better to use PACE and stimulus therapy together.

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    We report a case of aphemia who suffered from a cerebral infarction in the right frontal opercular region. The patient was a 61-years-old right handed male. His mother and brother were left handed. He suddenly noticed difficulty in speaking when he had been in a hospital due to acute myocardial infarction. On admission to our hospital he was alert. There was slight left hemiparesis and oral facial apraxia. He had no spontaneous speech, making a conversation in writing because of severe dysarthrophonia. He had normal comprehension to written and spoken language. He had no signs of aphasia, pseudobulbar palsy, or unilateral spatial neglect. An Xray CT and a magnetic resonance imaging (MRI) revealed a lesion due to cerebral infarction in the right middle and inferior frontal cortices. A single photon emission computed tomography (SPECT) using ¹²³I-iodoamphetamine disclosed severe decrease of cerebral blood flow in the right anterior opercular region. An MRI angiography showed no steno-occlusive lesion in the main trunks of right middle cerebral artery. An echocardiography revealed mural thrombi in the left ventricle. The patient was diagnosed as having an embolic infarction in the right middle cerebral artery branch territory. After admission, he showed gradual improvement in dysarthrophonia. Intentional speech was more difficult for him than automatic and emotional speech. Seven months after the onset of stroke, mild slowness of speech and dysprosody persisted as only deficits. In this case, dysarthrophonia with sparing of language function was regarded as aphemia, that was the anterior opercular syndrome in the right frontal opercular lesion in a dextral. The patient might have predominant language function on the right hemisphere with the family history of left handedness. It is suspected that the middle and inferior fontal cortices on the dominant hemisphere for the language function play an important role on articulation and phonation.

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    We reported five cases with sudden onset of severe supranuclear dysarthria and dysphagia following recurrent minor stroke.
    The subjects included one patient with bilateral putaminal hemorrhage, two patients with bilateral infarction in the region of the penetrating branches of the middle cerebral artery, one patient with putaminal hemorrhage followed by contralateral infarction, and one patient with putaminal hemorrhage after contralateral silent infarction. Four patients had almost improved before the recurrence damaging the contralateral hemisphere.
    The outstanding clinical features were severe dysarthria and dysphagia compared to minimal limb involvement. No gait disturbance, emotional incontinence, intellectual impairment, extrapyramidal signs, or sphincter disturbances were observed. CT scan showed bilateral lesions involving the genu of the internal capsule and/or the junction of the internal capsule with the corona radiata.
    These findings suggest that the corticobulbar tract is located in the genu of the internal capsule and the junction of the internal capsule with the corona radiata, and that bilateral damage to the corticobulbar tract at these levels could play an important role in the development of severe dysarthria and dysphagia.

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