A Comprehensive Overview of Broca’s Aphasia after Ischemic Stroke

Aphasia denotes an acquired central disorder of language, which alters patient’s ability of understanding and/or producing spoken and written language. The main cause of aphasia is represented by ischemic stroke. The language disturbances are frequently combined into aphasic syndromes, contained in different vascular syndromes, which may suffer evolution/involution in the acute stage of ischemic stroke. The main determining factor of the vascular aphasia’s form is the infarct location. Broca’s aphasia is a non-fluent aphasia, comprising a wide range of symptoms (articulatory disturbances, paraphasias, agrammatism, anomia, and discrete comprehension disorders of spoken and written language) and is considered the third most common form of acute vascular aphasia, after global and Wernicke’s aphasia. It is caused by a lesion situated in the dominant cerebral hemisphere (the left one in right-handed persons), in those cortical regions vascularized by the superior division of the left middle cerebral artery (Broca’s area, the rolandic operculum, the insular cortex, subjacent white matter, centrum semiovale, the caudate nucleus head, the putamen, and the periventricular areas). The role of this chapter is to present the most important acquirements in the field of language and neurologic examination, diagnosis, and therapy of the patient with Broca’s aphasia secondary to ischemic stroke.

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Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

10.21203/rs.2.46/v1 ◽

2018 ◽

Author(s):

Matthew Scalise ◽

Jordan Gainey ◽

Benjamin Bailes ◽

Leanne Brecthtel ◽

Zachary Conn ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Prognostic Models ◽

Broca's Aphasia ◽

Stroke Patients ◽

Motor Speech ◽

Stroke Registry ◽

Broca’S Aphasia ◽

Thrombolysis Therapy

Abstract Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = <0.001, CI =0.92-0.96), patients with congestive heart failure (OR = 0.496, P = 0.040, CI = 0.25-0.97), higher NIHSS (OR=0.876, P = 0.001, CI = 0.80-0.95), taking antihypertensive medication (OR = 0.436, P = 0.023, CI = 0.21-0.89) were not associated with improved ambulatory functional outcome with thrombolysis. The discriminating ability for the model was 74.2% for the total population, 71.7% for the rtPA group, and 72.2% for the no-rtPA group indicating strong performance. Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.

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THE HISTORICAL DEVELOPMENT OF THE STUDY OF BROCA'S APHASIA

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.02.8 ◽

2021 ◽

Vol 7 (2) ◽

pp. 125-128

Author(s):

Yoke Lian Lau ◽

Chek Kim Loi ◽

Mohd Nor Azan bin Abdullah

Keyword(s):

Brain Function ◽

Historical Development ◽

Written Language ◽

Broca's Aphasia ◽

Railway Company ◽

Broca’S Aphasia ◽

Localization Theory ◽

French Surgeon ◽

Experienced Difficulty ◽

Better Than

Broca's aphasia is a type of aphasia named after the French surgeon Broca. Broca's aphasic patients experienced difficulty in speaking, but they could understand both spoken and written language. There were three essential patients in the historical development of the study of Broca's aphasia. Louis Victor Leborgne (1809–1861) was also known as Monsieur Leborgne or 'Tan' as he could only utter the syllable 'Tan' throughout his 21 years of illness. The second patient was called Lazare Lelong. His language ability was slightly better than Leborgne. He could utter simple syllables, such as oui (yes), non (no), and this (trois or three). The third patient was Gage, a railway company worker. Broca studied similar cases in the following years and planned a brain function localization theory.

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Predicting ambulatory recovery in acute ischemic stroke patients with thrombolytic therapy

Future Neurology ◽

10.2217/fnl-2020-0002 ◽

2020 ◽

Vol 15 (2) ◽

pp. FNL45

Author(s):

Matthew Scalise ◽

Leanne Brechtel ◽

Zachary Conn ◽

Benjamin Bailes ◽

Jordan Gainey ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Odds Ratio ◽

Antihypertensive Medication ◽

Broca's Aphasia ◽

Stroke Patients ◽

Broca’S Aphasia ◽

Clinical Presentations

Aim: The aim of this study was to determine the predictive value of clinical presentations on functional ambulation following thrombolytic therapy. Materials & methods: Logistic regression analysis was used to determine associations between functional ambulation and thrombolytic therapy. Results & conclusion: In the results, Hispanic ethnicity (odds ratio (OR): 2.808; p = 0.034; 95% CI: 1.08–7.30), high National Institute of Health Stroke Scale (NIHSS) (OR: 1.112; p ≤ 0.001; 95% CI: 1.06–1.17), weakness/paresis (OR: 1.796; p = 0.005; 95% CI: 1.19–2.71), Broca’s aphasia (OR: 1.571; p = 0.003; 95% CI = 1.16–2.12) and antihypertensive medication (OR: 1.530; p = 0.034; 95% CI: 1.03–2.26) were associated with an improved ambulation in patients without thrombolytic therapy. In thrombolytic treated patients, Broca’s aphasia was associated with improved functional outcome.

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Variability of the Clinical Picture of Broca's Agraphia during Implementation of Different Cultural Functions of Writing

Clinical Psychology and Special Education ◽

10.17759/cpse.2020090107 ◽

2020 ◽

Vol 9 (1) ◽

pp. 121-141

Author(s):

E.G. Ivanova ◽

A.A. Skvortsov ◽

Yu.V. Mikadze

Keyword(s):

General Pattern ◽

Pairwise Comparison ◽

Semantic Content ◽

Left Middle Cerebral Artery ◽

Broca's Aphasia ◽

Chi Square ◽

Component Structure ◽

Broca’S Aphasia ◽

Cultural Functions ◽

Regulatory Functions

The research is devoted to the study of writing errors in patients with Broca’s aphasia performing the human-specific writing tasks. The object of the study is writing, the subject – disorder of writing in Broca’s agraphia. The aim of the research was to identify the most specific types of errors in writing language, depending on the cultural and historical significance of the actualized functions of writing language in Broca’s aphasia. Used instruments include classical neuropsychological assessment as well as specially developed experimental tasks aimed at actualization of cultural-historical functions of writing (communicative, mnestic and regulatory functions). Nonparametric Chi-square Friedman and Wilcoxon T-criteria used for pairwise comparison of data and analtysis of the distribution of errors. The study involved 22 patients with organic brain damage due to ischemic stroke in the basin of the left middle cerebral artery. Shown that the most specific grammatical errors were syntactic errors such as breaking of the sentence boundaries, omissions of independent and functional words, disorders of concordance and execution. Diversity in the performance of writing tasks that are similar in neuropsychological component structure but differ in functional purposes are explained by the choice of different strategies of writing. However, the general pattern is the dominance of the semantic content of the text over its formal structuring, expressed in grammatical rules. The research confirms that when studying agraphia, it is important to consider both structural (speech act operations) and functional (cultural and historical specific) aspects of writing.

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C-fos, ERK1/2, MAP2, NOTCH1 Proteins Expression Patterns in Human Cerebral Cortex Neurons after Ischemic Stroke

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1295 ◽

2020 ◽

Vol 75 (3) ◽

pp. 226-233

Author(s):

Svetlana P. Sergeeva ◽

Aleksey V. Lyundup ◽

Valery V. Beregovykh ◽

Petr F. Litvitskiy ◽

Aleksey A. Savin ◽

...

Keyword(s):

Cerebral Cortex ◽

Ischemic Stroke ◽

Expression Patterns ◽

Immunohistochemical Method ◽

Left Middle Cerebral Artery ◽

Contralateral Hemisphere ◽

Human Cerebral Cortex ◽

Fos Protein ◽

Urgent Task ◽

Indirect Immunoperoxidase

Background. The search for protein (these include c-fos, ERK1/2, MAP2, NOTCH1) expression that provide neuroplasticity mechanisms of the cerebral cortex after ischemic stroke (IS) patterns is an urgent task. Aims to reveal c-fos, ERK1/2, MAP2, NOTCH1 proteins expression patterns in human cerebral cortex neurons after IS. Materials and methods. We studied 9 left middle cerebral artery (LMCA) IS patients cerebral cortex samples from 3 zones: 1 the zone adjacent to the necrotic tissue focus; 2 zone remote from the previous one by 47 cm; 3 zone of the contralateral hemisphere, symmetric to the IS focus. Control samples were obtained from 3 accident died people. Identification of targeted proteins NSE, c-fos, ERK1/2, MAP2, NOTCH1 was performed by indirect immunoperoxidase immunohistochemical method. Results. Moving away from the ischemic focus, there is an increase in the density of neurons and a decrease in the damaged neurons proportion, the largest share of c-fos protein positive neurons in zone 2, NOTCH1 positive neurons in zone 1, smaller fractions of ERK1/2 and MAP2 positive neurons compared to the control only in samples of zone 1. Conclusions. With the IS development, the contralateral hemisphere is intact tissue increased activation zone, while the zones 1 and 2 have pathological activation signs. In zone 1 of the range, the adaptive response of the tissue decreases, and in zone 2 it expands. Therefore, a key target for therapeutic intervention is zone 2.

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The Effects of Augmented Reality Based Language Intervention on the Verb Naming Abilities of Patients with Broca’s Aphasia

JOURNAL OF SPECIAL EDUCATION & REHABILITATION SCIENCE ◽

10.23944/jsers.2020.03.59.1.12 ◽

2020 ◽

Vol 59 (1) ◽

pp. 245-263

Author(s):

Yoon-ji Kim ◽

Soon-Bok Kwon

Keyword(s):

Augmented Reality ◽

Language Intervention ◽

Broca's Aphasia ◽

Broca’S Aphasia

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SURG-40. SURGICAL RESECTIONS IN BROCA’S AREA DO NOT LEAD TO BROCA’S APHASIA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.886 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii212-ii212

Author(s):

John Andrews ◽

Nathan Cahn ◽

Benjamin Speidel ◽

Valerie Lu ◽

Mitchel Berger ◽

...

Keyword(s):

Inferior Frontal Gyrus ◽

Brain Surgery ◽

Broca’S Area ◽

Broca's Area ◽

Supramarginal Gyrus ◽

Broca's Aphasia ◽

Broca’S Aphasia ◽

Language Evaluations ◽

Lesion Symptom Mapping ◽

Normal Speech

Abstract Brodmann’s areas 44/45 of the inferior frontal gyrus (IFG), are the seat of Broca’s area. The Western Aphasia Battery is a commonly used language battery that diagnoses aphasias based on fluency, comprehension, naming and repetition. Broca’s aphasia is defined as low fluency (0-4/10), retained comprehension (4-10/10), and variable deficits in repetition (0-7.9/10) and naming (0-8/10). The purpose of this study was to find anatomic areas associated with Broca’s aphasia. Patients who underwent resective brain surgery in the dominant hemisphere were evaluated with standardized language batteries pre-op, POD 2, and 1-month post-op. The resection cavities were outlined to construct 3D-volumes of interest. These were aligned using an affine transformation to MNI brain space. A voxel-based lesion-symptom mapping (VLSM) algorithm determined areas associated with Broca’s aphasia when incorporated into a resection. Post-op MRIs were reviewed blindly and percent involvement of pars orbitalis, triangularis and opercularis was recorded. 287 patients had pre-op and POD 2 language evaluations and 178 had 1 month post-op language evaluation. 82/287 patients had IFG involvement in resections. Only 5/82 IFG resections led to Broca’s aphasia. 11/16 patients with Broca’s aphasia at POD 2 had no involvement of IFG in resection. 35% of IFG resections were associated with non-specific dysnomia and 36% were normal. By one-month, 76% of patients had normal speech. 80% of patients with Broca’s aphasia at POD 2 improved to normal speech at 1-month, with 20% improved to non-specific dysnomia. The most highly correlated (P< 0.005) anatomic areas with Broca’s aphasia were juxta-sylvian pre- and post-central gyrus extending to supramarginal gyrus. While Broca’s area resections were rarely associated with Broca’s aphasia, juxta-sylvian pre- and post-central gyri extending to the supramarginal gyrus were statistically associated with Broca’s type aphasia when resected. These results have implications for planning resective brain surgery in these presumed eloquent brain areas.

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Bivalirudin for Endovascular Intervention in Acute Ischemic Stroke: Case Report

Neurosurgery ◽

10.1227/01.neu.0000097556.08044.1f ◽

2004 ◽

Vol 54 (1) ◽

pp. 218-223 ◽

Cited By ~ 18

Author(s):

Mark R. Harrigan ◽

Elad I. Levy ◽

Bernard R. Bendok ◽

L. Nelson Hopkins

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Scale Score ◽

Intracranial Hemorrhage ◽

National Institutes Of Health ◽

Left Middle Cerebral Artery ◽

Computed Tomographic ◽

Left Middle ◽

Arterial Thrombolysis

Abstract OBJECTIVE AND IMPORTANCE Intra-arterial thrombolysis has been demonstrated to improve recanalization and outcomes among patients with acute ischemic stroke. However, thrombolytic agents have limited effectiveness and are associated with a significant risk of bleeding. Bivalirudin is a direct thrombin inhibitor that has been demonstrated in the cardiology literature to have a more favorable efficacy and bleeding profile than other antithrombotic medications. We report the use of bivalirudin during endovascular treatment of acute stroke, when hemorrhagic complications are not uncommon. CLINICAL PRESENTATION A 71-year-old woman with atrial fibrillation presented with right hemiparesis and aphasia and was found to have a National Institutes of Health Stroke Scale score of 10. Computed tomographic scans revealed no evidence of intracranial hemorrhage, aneurysm, or ischemic stroke. Cerebral angiography revealed thromboembolic occlusion of the superior division of the left middle cerebral artery. INTERVENTION For anticoagulation, a loading dose of bivalirudin was intravenously administered before the interventional procedure, followed by continuous infusion. Attempts to remove the clot with an endovascular snare failed to induce recanalization of the vessel. Bivalirudin was then administered intra-arterially. Immediate postprocedural angiography demonstrated restoration of flow in the left middle cerebral artery. Repeat computed tomographic scans demonstrated no intracranial hemorrhage. The patient's hemiparesis and aphasia were nearly resolved and her National Institutes of Health Stroke Scale score was 2 at the time of her discharge 5 days later. CONCLUSION To our knowledge, this is the first report of the use of bivalirudin for treatment of acute ischemic stroke. Bivalirudin may be a useful agent for intravenous anticoagulation and intra-arterial thrombolysis in this setting.

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