Four severe aphasic patients were taught 60 words of “LoCoS” the only semantography devised in Japan (Ohta, 1975), as therapy for visual communication. Two patients mastered all items. The third patient's learning of “LoCoS” was incomplete. In the fourth, therapy had to be discontinued because of intense perseveration. Three patients, including the one who stopped therapy, all tried to communicate with their families using visual symbols generated by themselves. One patient, who engaged in little conversation in daily life, used visual symbols to communicate with the therapist. From this outcome, the visual communication therapy seemed to be highly effective in developing the ability to generate “self-symbols”.

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    The patient was an 8 year-old boy who revealed clinical symptoms of Landau-Kleffner syndrome (aphasic-epileptic syndrome). Although he did not have a clinical seizure, his EEG findings consisted of multifocal centre-parietal predominant spike and wave complexes. His auditory imperception coincided with auditory agnosia, which includes both verbal and nonverbal deficits.
    A positive correlation was detectable between language disability and abnormal hyperactive behavior. These two clinical features improved after methylphenidate was administered, but deteriorated after diazepam. Therefore, it could be assumed that these medications may have affected clinical symptoms by changing vigilance.
    As for the etiology of Landau-Kleffner syndrome, two hypotheses have been postulated and discussed. One is “functional ablation” of language function by abnormal epileptic discharge, and the other is focal or chronic encephalitis. However, the case at hand did not accord with either of these hypotheses. He did not show a significant correlation between language function and EEG findings, which disproves direct “functional ablation” .
    On the other hand, no apparent evidence of focal or chronic encephalitis existed throughout the course of the case. It is thus necessary to assume the presence of a bilateral dysfunction of some system not restricted to the temporal lobes. A dysfunction of the cortico-subcortico-reticular system may be suggested.

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    A case of compulsive manipulation of tools (CMT) with left unilateral spatial neglect (USN) was reported. The patient was a 74-year-old right-handed male who had suffered from a stroke with occulsion of the left anterior cerebral artery and the right middle cerebral artery. Brain CT scan revealed a lesion in the medial parts of both frontal lobes, the genu of the corpus callosum and the right temporo-parietal region. Besides left hemiparesis, grasp reflex, and instinctive grasp reaction, CMT of the right hand was observed. No apraxias were seen. This case showed two remarkable characteristics which had not been reported before : (1) In spite of recognizing an object, the patient did not manipulate it compulsively when his eyes were closed, (2) He stopped manipulating it cnmpulsively when his eyes were averted from it. These facts suggest that in this case visual recognition of an obiect was indispensable for the manifestation of CMT. Moreover the CMT in this case disappeared in accordance with the USN. This phenomenon may be interpreted as a result of hyperattention to the right visual field due to USN.

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    Forty aphasic patients with left unilateral hemisphere damage were tested in two non-verbal color tasks (coloring drawings of objects and pointing to appropriately colored drawings) and verbal tasks (SLTA, the naming and auditory comrehension of colors and the same drawings employed in non-verbal color tasks) in order to obtain information about the relationship between impaired performance on the non-verbal color tasks and aphasic disorder. Moreover, the relation between coloring performance and ability to recall the form of named objects or to draw their pictures was studied.
    Results revealed that half of the aphasics scored below the poorest normal in the coloring task, namely, 4 global, 3 severe Broca's (with damage encroaching upon the posterior region), 5 Wernicke's (severely impaired in word meanings), 4 amnesic, 1 transcortical sensory, and 3 unclassified aphasics. There was a significantly high correlation between the scores of the two non-verbal color tasks. The performances for coloring of drawings showed no correlation with those for reading aloud and repetition, but significantly correlated with those for comprehension and word finding. There was no correlation between the scores for coloring and drawing of pictures.
    The inability of aphasics to associate non-verbally drawings of objects with their specific characteristic colors is interpreted as an impairment in the process of isolating and recognizing attributes of objects or the process of handling a concept, and is not concerned with the phonological process.

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    Long-interval palilalia (LIP) and echopalilalia observed in a case of senile dementia (Pick's disease suspected) was reported. Echolalia (repetition of examiner's question) and LIP (repetition of the patient's own answer with a long interval) were independent to each other in the initial stage of our observation. Several months later both speech symptoms were combined to the form of echopalilalia, in which the patient repeated several times only a part of the question with short interval. The implications of the symptomatological change were discussed from the clinical point of view.

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    The purpose of the present study is to reveal the relationship of localized and / or diffuse cerebral lesions to constructional abilities. The constructional abilities were examined by copying a cube, and brain lesions were estimated by planiometry on computed tomograms of brains of 144 patients.
    The results are summarized as follows.
   1. Patients with especially right posterior hemispheric lesions without diffuse brain damage showed marked constructional disabilities and left hemispatial neglect.
    2. Constructional impairment associated with left brain damage without diffuse cerebral lesions were slight, but showed many mistakes on the right lower corner space.
    3. Patients with unilateral cerebral lesions without diffuse cerebral damage showed a similarity in numbers of stroke lines used in copying the cube.
    4. Patients with diffuse cerebral lesion also showed marked constructional impairment. Constructive disabilities associated with diffuse parietal lobe atrophy were characterized by recopying the same lines numerous times, left hemispatial neglect and perseveration. Patients with ventricular dilatation also showed constructional impairment, which are assumed to be influenced by abulia.
    5. The influence of diffuse cerebral lesions on the constructional disablities are emphasized in relation to the evaluation of focal signs.

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    In 44 patients with aphasia due to cerebral infarction, the positron emission tomographic studies (PET) were carried out using the ¹⁵O steady-state method. According to the type and severity, aphasic patients were divided into 2 groups, respectively. There were 18 cases with motor aphasia, and 20 cases with sensory aphasia. Another 6 cases were global aphasia. Twentyeight cases were classified as the mild group, while 16 cases served as the severe group. The regions of interest (ROIs) for quantitative measurement of cerebral blood flow and oxygen consumption were outlined as 7 cortical regions on each cerebral hemisphere. The regional values were calculated by averaging the 405 pixels data at each ROI ; regional cerebral blood flow (rCBF) and regional oxygen consumption (rCMRO₂). The mean value for the cerebral hemisphere was caluculated by averaging the 7 regional values ; mean CBF (mCBF) and mean CMRO₂ (mCMRO₂). Seven patients with an infarction in the region of the left renticulostriate arteries served as a control group.
    1. Relationship between the types of the aphasia and the PET data
    In the control group, rCBF and rCMRO₂ at the poterior frontal region (PF) on the dominant hemisphere which covers the Broca's area, were 37.4 ± 6.4 (ml / 100 g / min) and 2.75 ± 0.35 (ml / 100 g / min), respectively. Those at the posterior temporal region (PT) on the dominant hemisphere which covers the Wernicke's area, were 36.4 ± 4.2 and 2.76 ± 0.38. In the motor aphasia group, the rCBF and rCMRO₂ at the PF were 19.9 ± 9.3 and 1.26 ± 0.93, and those at the PT were 27.5 ± 6.6 and 2.19 ± 0.70. In the sensory aphasia group, rCBF and rCMRO₂ at the PF were 30.7 ± 7.0 and 2.40 ± 0.69, and those of the PT were 23.7 ± 8.0 and 1.86 ± 0.66. The rCBF and rCMRO₂ at the PF in the motor aphasia group, and those in the PT of the sensory aphasia group were significantly lower than those in the control group. The rCBF and rCMRO₂ at the PF were significantly lower in the motor aphasia group than in the sensory aphasia groups. The present study suggests that the motor aphasia was associated with the ischemia in the left posterior frontal lobe.
    2. Relationship between the severity of the aphasia and the the PET data.
    In the control group, the mCBF and mCMRO₂ were 37.5 ± 5.1 and 2.83 ± 0.38, respectively. The rCBF and rCMRO₂ at the language area, which is obtained by averaging the values of left PF and PT, were 36.9 ± 5.2 and 2.76 ± 0.34. In the mild aphasia group, the mCBF and mCMRO₂ were 29.1 ± 6.4 and 2.26 ± 0.57, The rCBF and rCMRO₂ at the language area were 27.7 ± 6.3 and 2.17 ± 0.60. In the severe aphasia group, the mCBF and mCMRO₂ were 21.3 ± 5.9 and 1.52 ± 0.49. The rCBF and rCMRO₂ at the language area were 18.7 ± 6.5 and 1.20 ± 0.50. In the mild aphasia group, the values of rCBF and rCMRO₂ at the language area as well as mCBF and mCMRO₂ were significantly reduced as compared to the control group. The severe aphasia group showed the same reductions as compared to the control and mild aphasia groups. The present study suggests that measurements of cerebral blood flow and oxygen consumption are valid for the evaluation of the severity of aphasia due to cerebral infarction.

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    We reported a patient with aphasia whose speech exhibited two different features ; one was an intentional and prepositional utterance that was produced non-fluently, and the other was an automatic and stereotyped utterance that was produced fluently. The structure of the speech production in this patient corresponded to the “fluctuating” stage in the evolution of recurring utterance (Alajouanine, 1956). The type of aphasia of this case was regarded as mixed aphasia consisting of elements of Broca aphasia and non standard fluent global aphasia. His recurring utterance could be interpreted as adaptation-behavior resulting from stess. ( Weinstein et al., 1974)

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