The Japanese journal of neuropsychology

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ArticleTitle	A case of crossed aphasia with agrammatism and echolalia
Language	J
AuthorList	Masako Abe¹⁾, Sumio Ishiai²⁾, Keiko Seki³⁾, Takako Miwa⁴⁾
Affiliation	¹⁾Course of Speech-Language-Hearing Therapy, College, National Rehabilitation Center for Persons with Disabilities ²⁾Department of Rehabilitation, Sapporo Medical University School of Medicine ³⁾Faculty of Health Sciences, Kobe University School of Medicine ⁴⁾Miwa Neurological Clinic
Publication	Japanese Journal of Neuropsychology: 24 (4), 282-290, 2008
Received	Jan 8, 2008
Accepted	May 22, 2008
Abstract	We reported a case of crossed aphasia who exhibited agrammatism and echolalia. The 53-year-old purely right-handed man developed left hemiparesis, left unilateral spatial neglect and aphasia following an infarction of the right cerebral hemisphere. On admission to our hospital about one month after the onset, he demonstrated aprosodic and telegraphic speech with mild word finding difficulties. Peculiar echolalic repetitions had been observed for several days. Confrontation naming was good. His auditory comprehension was well preserved for words but disturbed for grammatically complex sentences. Reading comprehension was also disturbed for complicated constructions. Concerning his writing ability, he could write words fairly well, while he often wrote ill-structured sentences. First, we quantitatively analyzed the agrammatic productions. Three types of tasks, free conversation, oral picture description and writing picture description were employed, and the following results were obtained. The differences exist in the character of agrammatism between the free conversation and oral picture description. In the free conversation, telegraphic speech was prominent. The omission rate of particles was higher in the free conversation than in the oral picture description. The number of words per unit time was also higher in the free conversation than in the oral picture description. The differences also exist in the character of agrammatism between the oral and writing picture description. The patient made fewer particle errors in the writing than in the oral picture description. However, from the analysis of writing processes, pauses and insertions of passages were observed. The above-mentioned results of the patient suggest that telegraphic speech characterized by the omission of particles may occur in the conditions which require higher output speed characterized by words per unit time. The pauses and insertions are considered to be the strategies not to make wrong sentences only in the case of writing. These strategies may have contributed to the lower occurrence rate of particle errors in the writing picture description. Second, we analyzed the echolalic repetitions which were observed in both free conversation and examination. The patient was aware of his echolalia but could not control it. We found the echolalic repetitions were characterized by syntacs errors. Those syntacs errors were similar to the ones observed in the spontaneous speech. It is suggested that the patient may compulsively initiated repetition of sentences spoken to him and cannot inhibit the continuation of his speech.
Keywords	agrammatism, telegraphic speech, echolalia, crossed aphasia, right hemispheric lesion