A 54-year old, right-handed man with left-handed disposition developed alexia with agraphia after an occlusion of the left internal carotid artery. His CT scan revealed widespread left fronto-parietal lesions in areas including Broca's area, Wernick's area and the angular gyrus.
    Neurological examination showed right hemiplegia, right homonymous hemianopsia, ideomotor apraxia, constructional apraxia, color agnosia, finger agnosia, acalculia, and topographical disorientation.
    His speech was normal except for some verbal paraphasia which did not effect his ability to carry on common conversation. The language function test one month after the onset of the disease showed only mild dysfunction in his oral language, i. e., a slight disturbance of his auditory comprehension and ability to find words. In contrast to the minimal oral language dysfunction,the disturbance in his reading and writing ability was marked. His oral reading was more disturbed than his reading comprehension. Moreover, his reading ability in “kana” was poorer than in “kanji” . He had no sign of motor facilitation. He could not write any letters except his name. He could copy simple letters and figures but could not copy a cube or complicated letters.
    His speaking and listening ability was almost normal three months after onset, but the disturdance in reading and writing remained unchanged.
    In spite of the widespread lesion of the left hemisphere and the gross impairment of written language, the oral language dysfunction was very mild and transient. These findings suggest the separation of oral and written language functions in two cerebral hemispheres of this patient, the former in the right or both and the latter in the left.

View full abstract

     A 47-year-old, right-handed female with right thalamic hemorrhage presented with left-sided unilateral spatial neglect (USN). USN had disappeared about four months following an onset of the disease, but pseudo-simultanagnosia persisted. Brain CT scan disclosed a high density area located in the right thalamus, extending to the internal capsule laterally and to the third ventricle medially. These findings support a recent concept that a posteromedial portion of the right thalamus may play a major role for producing USN, and also suggest that posterior limb of the internal capsule may take part in USN occurrence. Disordered pursuit and saccadic eye movement toward the left side i. e. neglect side were noted throughout the follow-up period. The abnormal saccade may be considered as the result of damage of the saccade fiber system descending from the frontal eye field. On the other hand, there may be another explanation that visually-guided eye movement such as pursuit and saccade was impaired as the result of visual input deficit due to USN.

View full abstract

     This study attemped to analyze the quantitative and qualitative effect of hematoma within in the thalamus on the constructional function and discussed about Corticothalamic fiber connection.
    46 patients weth left thalamic hemorrhage (left-group) and 31 patients with right thalamic hemorrhage (right-group) were analyzed with WAIS (performance), Coloured Matrices and Benton's Visual Retention test A at average 35 days after onset.
    Quantitaively, no differences in WAIS were observed between the two groups. In the sites of hematoma it revealed that group 1 (middle and localized) showed “dull normal” , group 2 (dorso-lateral without rupture into the ventricle) and group4 (anterior) showed “borderline” , and group 3 (dorso-lateral with rupture into the ventricle) showed “mental defective” .
    Qualitatively, the analysis of the result of Coloured Matrices revealed that “reduction of thinking” and “no-response” predominated in left-group. On the other hand, “inattention” was dominant in right-group. Benton's Visual Retention Test A showed that “omission” in left-group and “distortion” in right-group were dominant respectively.
    Our observations were good agreement with the given by Hartje et al, regarding the difference of the quality of constructional disability originating from left or right cerebral hemispheres, and we concluded that these impairment accompanied by thalamic hemorrhage depends on the damage to the fiber connections between the thalamus and cerebral cortex.
    Also, in the right group incorrective selection of left and right sides of Coloured Matrices was in the ratio of 1.0 : 3.1 respectively. This result seems to support the theory by Uemura et al, regarding the development of non-verbal abstract conception (i. e., visual space, recognition, etc.) owing to integration by the thalamus and non-dominant hemisphere.

View full abstract

     This study examined comprehension performance of aphasics in the sentence verification task. It is reported that there are four stages in the sentence verification task, namely : picture, decoding sentence, decoding comparison, and response. The goal of this study was to specify the damaged stage in the sentence verification task. The subjects were 26 aphasics. The stimuli consisted of two types of active sentences. Measurement methods were the sentence verification task and the picture construction task.
    The major findings were as follows :
    1) Performance of the picture consrtuction task was significantly better than that of the sentence verification task.
    2) Subjects unable to understand the sentence in the sentence verification task were divided between those who could understand the sentence in the picture construction task and those who could not.
    These results suggested that subjects unable to understand the sentence in the sentence verification task were divided between those who have defect in the decoding stages and those who have defect in the comparison and response stages.

View full abstract

    As a simple clinical test of vigilance (sustained attention), the continuous tapping task with a constant tempo ( Sakatsume, et al., 1986) was applied to many brain-damaged subjects ( N = 333). Each subject was instructed to tap a table continuously at the rate of once persecond with a pencil held in his normal hand.
    The examiner, relying on a stopwatch, counted and recorded the number of tapping sounds per block of ten seconds for a duration of five minutes. As the index of this task, the mean (response tendency) and SD (response oscillation) values of tapping sound numbers for thirty blocks were used. It was expected that performance of the task would fluctuate if vigilance was disturbed.
    The results were as follows. First, patients demonstrating difficulty with this task were more numerous in the right-brain-damaged group with mental symptoms (about eighty percent) than in other groups (below fifty percent). Secondly, diffculty in this was most related to left unilateral spatial neglect patients having mental disorder. Fmallly, two specific patterns of difficulty in performance of this task were observed. One was “high tendency and high oscillation” . The other was “standard tendency and high oscillation ” .
    These results suggest that the vigilance function is more readily disturbed in right brain da mag ethan left, and that the performance pattern in this task is dependent on the balance between “fixationability ” and “ conversionability ” of fundamental attentional functions.

View full abstract

     A retrospective investigation was made into the recovery processes of the auditory comprehension of twenty-two post -stroke aphasic patients treated at the Speech Clinic of the Seikeikai Hospital beween 1978 and 1986. The two sub-tests of the Standard Language Test of Aphasia (SLTA) —Short Sentence Comprehension (No. 2 ) and Oral Command (No. 3 ) -and the Seven Graded Aphasia Sacle were used for comparison. Fourteen subjects underwent the SLTA six months after their onset and were retested more than three times at a three to twelve month interval. Eight subjects underwent the SLTA more than three times after one year of their onset. The results were as follows. (1) After six months postonset, the severity of the disturbances in auditory comprehension did not change significantly. It was suggested that the score of the SLTA at the six-month postonset was important to predict the severity of the disturbances in the future. (2) Although the severity of the disturbances in auditory comprehension after six months postonset did not change in most of the patients, there were some patients who showed improvement in the score of the SLTA and ⁄ or the Seven Graded Scale. (3) After some period of plateau, out of the twenty-two cases, three patients showed some improvement in the score of the SLTA and ⁄ or the Seven Graded Scale. It was suggested that long-term follow-up was important to study the recovery processes of aphasics.

View full abstract

    A case of anomia coupled with word comprehension difficulty was reported. The symptoms were chronic and stable for more than a year. The patient was a 63-Yearold right-Handed store manager who suffered a left temporal hemorrhage on January 25, 1985. The hematoma was evacuated immediately but fluent neologistic aphasia became apparent. Wernicke aphasia improved slowly over the next several months, and by the end of one year language difficulty became confined to word handling. Comprehension of syntax and repetition returned. The neologism which bad been prominent initially became extinct.
The core symptoms of word handling difficulty were characterized by the following features :
    (1) Difficulty of word finding in running speech.
    (2) Difficulty of confrontation naming with no category specificity.
    (3) Difficulty of word comprehension.
    (4) Difficulty of word comprehension also did not have category specificity, but showed confusion among semantically related objects.
    (5) Words with naming difficulty and words with comprehension difficulty were not constant and varied depending on test sessions.
Two mechanisms could possibly explain this highly selective word handling difficulty : disorganization of semantic memory structure for words, or obstruction of the access route to the intact word store.
The former explanation seems more plausible, but the latter cannot be dismissed completely. It is highly probable that word processing and syntax processing are subserved by different neurological structures, and that the former is related with the left temporal lobe.

View full abstract

    During the three year period from 1983 to 1985, 83 patients with aphasia received language treatment in our hospital. To assess the prognosis of aphasia after discharge, we analyzed 62 cases whose family answered our family question (FQ) for the Test of Communication Abilities in Daily Living (CADL). The score of FQ and the performance of Standard Language Test of Aphasia (SLTA) showed a good correlation, especially in the score of the daily conversation (γ = 0.77, P < 0.001). We subdivided those cases into three groups (good, poor, bad) , according to the score of FQ. The group with good prognosis demonstrated high scores in writing, speaking and calculating, when comparing with that with poor prognosis.

View full abstract

     A case of Luria's semantic aphasia marked by difficulty in decoding sentences involving logico-grammatical relationships was observed in a 72-year-old right-handed woman. Her CT scan disclosed a lesion in the left parietooccipito-temporal region. She developed ideomotor apraxia, ideational apraxia, constructional apraxia, constructional agraphia, acalculia, and minimum right-left-disorientation.
    Neuropsychological examinations using the Standard Language Test of Aphasia, Token Test and Vocabulary Test showed that she had good comprehension and could memorize long sentences. The sentences which were difficult for her to comprehend were those having logico-grammatical relationships with double or triple elements, which therefore demanded simultaneous spatial organization.
    She decoded these sentences by means of word order. It was believed that she could not understand their actual meaning and comprehended only the meaning of the words in order, independent of syntax or context. The basic psychological disturbance in her behavior, it seemed, was an inability to process incoming information according to its logico-grammatical relationship. In order to understand sentences with a logico-grammatical relationship, simultaneous arrangement of the elements in the sentence is necessary, but the subject was unable to do so because she could not select the main element in the sentense according to the context.
    This disturbance was recognized not only in understanding sentences but also symbols, e. g., a watch hand or digits. For example, the meaning of a digit is decided according to its simultaneous spatial arrangement ( 1 signifies one when found to the right side of digit 3 in 31, but ten when found to the left of the same digit in 13). In these instances, she decoded the digits apart from their spatial arrangement. Therefore she was able to calculate no higher than a number with one digit.
    These findings suggest the subject was unable to transfer informations with simultaneous spatial organization to the higher symbolic level. This is because, even after she showed improvement in spatial functioning in constructional apraxia and right-lift disorientation, logico-grammatical disturbance was still recognized.

View full abstract

     The aim of the present research consisted in studying if in aphasia the signs of semantic impairment that can be observed in word finding or confrontation naming are related to how lexical components are organized. Twenty aphasic patients with unilateral left hemisphere lesions, ten non-aphasic patients with unilateral right or left hemisphere lesions and ten demented patients with neurological disease were assessed on a battery of non-verbal test designed to investigate semantic categorization in mental lexicon. The aphasic patients had been divided into three clinical syndromes : 11 Broca's, 6 Wernicke's and 3 amnesic aphasia. A test of semantic categorization was afforded by the “Visual Reception” and “Visual Association” subtests of the Illinois Test of Psycholinguistic Abilities (ITPA). The ITPA was designed as a diagnostic test of language and related perceptual-communication process. The “Visual Reception” subtest requires the subject to match two exemplars of the same semantic category, independently of perceptual representation. The “Visual Association” subtest samples a variety of other meta-semantic relations.
The non-aphasic group showed good performance and was equally competence to decode and associate picture over the level of a 8 year old child.
The aphasic group was equally competence to decode picture at the level of a 9 year old child, but was significantly impaired on the test of picture-association. The demented group exhibited severe impairment across subtests of the ITPA. Semantic errors in the “Visual Association” subtest obtained by aphasic aphasic showed a prevalence of affective recognition. It was suggested that the lexical structures produced by aphasics were semantically restricted.

View full abstract