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Aphasia, Agraphia and Apraxia of Speech Following Right Hemisphere Basal Ganglia Lesion: Implications for Language Laterality
Poster Session A, Friday, September 12, 11:00 am - 12:30 pm, Field House
Venu Balasuramanian1, Charlotte Lavendar1, Brittany Hague1, Regan Bonforte1, Christina Barnes1; 1Seton Hall University
Introduction. In recent decades, a detailed picture of language lateralization has emerged: Language Laterality (LL) can differ across the sub-processes (speech production, perception, and reading) and across individuals (Haegen & Cai, 2019). This view, known as the gradient view of LL, is currently gaining ground while the dogma of non-dominant hemispheric role in language is less preferred. For instance, recent brain stimulation research highlighted the functional role of cortico-subcortical structures of the right hemisphere for LL (Vilasboas, Verber, & Duffau. 2017). Greater role for RH in language functions came to be recognized in recent studies of variability in LL (Knecht et al, 2000., Labache et al, 2023). In the backdrop of the recent developments in LL research, the current study discusses a case with crossed aphasia. Objectives: To present a case of non-fluent aphasia with apraxia of speech and central agraphia following a right hemisphere basal ganglia lesion, and to discuss the implications of the constellation of language-related symptoms for the evolving theories and models of language laterality. Method. A retrospective single case study . Subject. SE, a 69-year -old female had a sudden onset of aphasia and left hemiplegia. Neuroimaging studies of her brain revealed a hemorrhagic lesion in the right head of the caudate and putamen (See Figure 1.). Her language was categorized as global aphasia in the first week after onset. Seven weeks post-onset, her aphasia syndrome evolved into agrammatic Broca’s aphasia. At this stage, symptoms of apraxia of speech (AOS) and limb apraxia have persisted. Her LVF neglect also persisted. Clinical observation revealed difficulties in writing/spelling to dictation. Experimental Tests. The following tests were performed to obtain comprehensive information on her aphasia, apraxia of speech and dysgraphia: Boston Diagnostic Aphasia Examination (BDAE), Apraxia Battery for Adults (ABA), and Psycholinguistic Assessment of Language Performance in Aphasics (PALPA). Additionally, a review of research on nonfluent aphasia following left versus right hemisphere lesion, a review of apraxia of speech causing lesions, and a review of lesions causing central agraphia were completed. Results from these reviews will be used in discussing the right hemisphere’s role in language and speech production, and graphic performance of SE. Results. On BDAE, SE’s performance profile was indicative of agrammatic Broca’s aphasia. The ABA test results revealed the presence of moderately severe AOS. On PALPA test, SE’s writing performance was indicative of the presence of central (phonological) agraphia. Conclusions. The current study supports the view that the BG of the RH plays an important role in language production. Results of lesion studies reviewed indicated that the lesions in BG were almost equally distributed between the two hemispheres. Recent brain stimulation research also offers support to this conclusion. Regarding AOS, no agreement exists among researchers regarding a common site of lesion. However, BG lesions were reported in numerous cases of the acquired neurogenic stuttering (ANS). Dysgraphia as well as aphasia and AOS in SE indicate that the crossover of LL was a global shift in cortical organization, probably due to genetic factors (Labache et al, 2023).
Topic Areas: Disorders: Acquired, Writing and Spelling