Aphasia

Aphasia is a language disorder involving the degradation of understanding of words or word production or non-verbal equivalents of words. It results from a malfunction of the language centers in the cerebral cortex and basal ganglia or the connecting webs in the white matter. The diagnosis is made clinically, often it also includes neuropsychological Tets. To identify the cause of an imaging of the brain (CCT, MRI) is initiated. The prognosis depends on the cause and the extent of damage and the age of the patient. There is no specific treatment, but a speech therapy can promote recovery.

In right-handed and about two-thirds of the left-handed, the language function is located in the left hemisphere. In the other third of the left-handed, much of language function is located in the right hemisphere. Cortical areas that are responsible for language function:

Aphasia is a language disorder involving the degradation of understanding of words or word production or non-verbal equivalents of words. It results from a malfunction of the language centers in the cerebral cortex and basal ganglia or the connecting webs in the white matter. The diagnosis is made clinically, often it also includes neuropsychological Tets. To identify the cause of an imaging of the brain (CCT, MRI) is initiated. The prognosis depends on the cause and the extent of damage and the age of the patient. There is no specific treatment, but a speech therapy can promote recovery. In right-handed and about two-thirds of the left-handed, the language function is located in the left hemisphere. In the other third of the left-handed, much of language function is located in the right hemisphere. Cortical areas that are responsible for language function: Posterosuperiorer temporal lobe (which Wernicke’s area included) Adjacent inferior parietal lobe Posteroinferiorer part of the frontal lobe in front of the motor cortex (Broca’s area) subcortical connection between these regions Damage to each part of this about triangular area (eg., by infarction, tumor, trauma or degeneration) influenced aspects of language function. A prosody (rhythm and quality of the emphasis that give the language meaning) is mostly influenced by both hemispheres, but sometimes also by a sole fault of the non-dominant hemisphere. Aphasia differs from a language impairment and functional disorders of the motor nerves and muscles that are responsible for speech production (dysarthria). Etiology aphasia arises n usually from disorders that cause progressive damage (such as stroke, head trauma, encephalitis.); in such cases, the aphasia does not deteriorate. Sometimes it results from a progressive disease (eg of expanding brain tumor, dementia.); In such cases, aphasia is progressive and worsens. Aphasia forms are roughly divided into receptive (sensory) and expressive (motor) aphasia. Receptive aphasia (sensory, liquid or receptive aphasia) patients can not understand words yet recognize auditory, visual or tactile symbols. It is a disorder of posterosuperior temporal gyrus of the language dominant hemisphere caused (Wernicke’s area). Often there is also a Alexie (loss of ability to read words). Expressive aphasia (motor, unflüssige or expressive aphasia): The ability to word formation is impaired, the word understanding and to think conceptually the assets are, however, relatively conserved. It is based on a disorder that affects the dominant left frontal or frontoparietal area, incl. The Broca’s area. They often causes agraphia (loss of ability to write) and hinders the reading. There are other types of aphasia (see table: aphasia types) that can overlap considerably. No aphasia classification system is ideal. It is often the most accurate to describe the kind of deficits to designate a particular aphasia. Aphasia types Type site of the causative lesion * Common causes speech patterns anomisch lesion (usually small) throughout the left hemisphere language areas Various disorders anomie in the spoken language (resulting in content-empty, circumscribing, paraphasischem speaking) and in the written language, fluency, good hearing and reading comprehension, normal word repetition expressive aphasia (unflüssig, expressive, motor) Large Lesion in the left frontal or frontoparietal area, incl. The Broca’s area infarction bleeding trauma tumor anomie in the spoken and written language, unflüssige speech (slow, labored production, short sentences, impaired prosody and limited use of prepositions and conjunctions) good word comprehension, impaired repetition of words, impaired writing (agraphia) Wernicke’s aphasia (fluent, receptive, sensory) Large lesion in the left temporoparietal area, incl. Wernicke’s area infarction tumor anomie in spoken and (written language, fluency with paraphasias, a variety of grammatical forms, but often little Meaning convey), poor understanding of belonging and written words, impaired word repetition, Error reading (Alexie), agraphia line Due subcortical lesion in the left hemisphere, often below the superior temporal gyrus or below the lower parietal lobe infarction bleeding tumor anomie (with significant paraphasias ), otherwise fluency, good word comprehension, impaired repetition of words (with frequent paraphasias), good reading comprehension letter does not affect Global Large lesion in the left frontotemporoparietalen area, incl. the Broca and Wernicke area Infarct bleeding trauma tumor severity anomie in the spoken and written language, unflüssiges Talk (often with low output), low word comprehension, impaired repetition of words, Alexie, agraphia Transkortikal motor lesion in the left frontal area, with the exception of Broca’s and Wernicke’s area infarction encephalitis bleeding trauma tumor Similar to the expressive aphasia, except for normal word repetition articulation often unaffected Transkortikal sensory lesion in the temporoparietal area, with the exception of Broca and Wernicke’s area Infarction encephalitis bleeding trauma tumor Similar to the receptive aphasia, except for normal word repetition * Pegged lesion is in the language dominant hemisphere (usually the left). Symptoms and complaints receptive aphasia Patients speak normal words fluently and use frequently meaningless phonemes, but they do not know the meaning of words or their references to each other. The result is a “word salad.” Patients are typically unaware that their language is incomprehensible to others. One limitation of the right visual field often accompanies a receptive aphasia because the visual track in the vicinity of the affected area verläuft.Broca Aphasia Patients can understand and form concepts relatively well, but their ability to articulate words is hindered. The impaired speech production and writing skills (agraphia, dysgraphia) normally frustrate the patient in their attempts to communicate a lot. However, oral and written communication for the patient make sense. The expressive aphasia may comprise a Anomie (inability to object naming) and disturbance of the prosody. Diagnostic exclusion of other communication problems studies at the bedside and neuropsychological tests brain imaging in a conversation marked aphasia can be identified typically. However, the physician should try to distinguish aphasia communication problems resulting from a severe dysarthria or by hearing, vision defects (eg. As in the assessment of reading performance) or limited motor skills when writing. At the beginning of a receptive aphasia can be mistaken for delirium. However, the Wernicke Aphasia is a pure speech disorder without other signs of delirium (z. B. fluctuating state of consciousness, hallucinations, inattention). The investigation at the bedside to identify specific deficits should include a survey of the following: spontaneous speech: the language is checked for verbal fluency, the number of spoken words, the ability to voice initiation, spontaneous errors, word finding pauses, hesitations and prosody. Name: The patient will be asked to name objects. Those who have difficulties with, often (z. B. “what you’re used to indicate the time” for “PM”) use descriptions. Repeat: Patients are asked to repeat grammatically complex sentences (eg “no ifs, and buts”.). Understanding: Patients are asked to point to objects, calling the doctor to follow simple commands or multistage and respond to simple and complex yes-or-no questions. Reading and writing: Patients are asked to write spontaneously and read. Reading comprehension, spelling and writing from dictation to be assessed. A standardized cognitive assessment by a neuropsychologist or speech therapists can discover more easily pronounced disorders and assist in treatment planning and exploration of the recovery potential. There are several standardized tests aphasia (eg Boston Diagnostic Aphasia Examination, Western Aphasia Battery, Boston Naming Test, Token Test, Action Naming Test;. Translator’s note .: In Germany, the Aachen Aphasia test is performed..). Imaging (CT, MRI, with or without angiographic sequences) is used to characterize the lesion (z. B. infarction, hemorrhage, mass) is required. If necessary, further investigations to clarify the cause of the lesion (eg., Stroke examination) are performed. Forecast recovery is affected by: basic size and location of lesions extent of language error response to therapy To a lesser extent, age, education, and general health of the patient often reach children <8 years after severe damage again their language ability through the failover of other hemisphere. After this age, it is the largest recovery within the first 3 months, however, a continuous improvement of varying amounts can even up to one year continue. Treatment treatment of the cause speech therapy enhancing communication aids treatment of certain lesions can be very effective (for. Example, corticosteroids, when a lesion caused vasogenic edema). The benefit of treatment of aphasia alone is unclear, but most clinicians believe that treatment helps by qualified speech therapists, and that patients who are treated as soon as possible after the onset of injury, benefit the most. Patients who can not regain basic language skills, and their caregivers however manage to convey messages with supported end communication aids (eg. A book or a communication board, the images or symbols of the daily needs of a patient show computer-based devices). Key points The language function is in the left hemisphere in right-handed and two-thirds of left-handers. A certain aphasia should be described by the description of the types of deficits because overlapping types of aphasia and no classification system is ideal. Evaluate to repeat the patient's ability to appoint at the bedside, to understand, to read, to write and run them through a brain imaging and tighten neuropsychological tests into consideration. done if possible causal treatment and speech therapy should be recommended.

Health Life Media Team

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