Variations in the presentation of aphasia in patients with closed head injuries

Speech and Language Dysfunctions in Patients with Cerebrocortical Disorders Admitted in a Neurosurgical Unit

Introduction

Speech and language abnormality among brain injury patients are common, especially during the acute stage. The details of same from Andhra Pradesh (AP) state are limited. The present study provides details of speech and language abnormality among brain damage patients, from a tertiary care hospital AP.

Materials and Methods

This study was conducted at tertiary care hospital, Nellore, AP. Patients with acute brain damage due to traumatic brain injury (TBI), cerebrovascular accident (CVA), and postoperative cases of brain tumors were selected for the study. Detail of speech and language disturbances was accessed using Western Aphasia Battery. All patients were right-handed and Telugu was their first language.

Results

There were totally 38 patients, of them 28 had TBI, 8 patients were postoperative cases of brain tumor, and 2 cases were of CVA. The mean age was 45.6 years. A total of 22 patients were literate. TBI patients with left cerebral hemisphere damage manifested with anomic, conduction, transcortical sensory, global, and Wernicke's aphasia. Four patients of postoperative brain tumor manifested with anomic and transcortical sensory aphasia had left-sided brain damage and mild dysarthria had right-sided brain damage patient. CVA patients had anomic aphasia and subcortical aphasia having right and left cerebral hemisphere damage, respectively.

Conclusions

This study reports that acute brain damage due to various causes manifest with speech and language abnormality, especially when the left cerebral hemisphere is involved.

"Stuttering" after minor head trauma

Traumatic brain injury (TBI) is defined as impairment in brain function as a result of mechanical force. It is classified based on clinical findings using the Glasgow Coma Scale (GCS). Mild TBI is defined as GCS 14-15; moderate, 9-13; and severe, 3-8. Patients with the same TBI classification may have very different underlying pathology. In moderate to severe TBI, the primary pathology may include contusions, hemorrhage, diffuse axonal injury, direct cellular damage, "tearing and shearing of the tissues, loss of the blood-brain barrier, disruption of the neurochemical homeostasis and loss of the electrochemical function". Although the primary pathology associated with mild TBI may be milder versions of the same pathology associated with moderate and severe TBI, it is generally a metabolic injury. However, it is reported that 15% of patients with mild TBI and a GCS score of 14 or 15 will have an intracranial lesion; less than 1% of these require neurosurgical intervention. Although patients with mild TBI may have intracranial lesions, it is rare that the presenting and only physical examination finding is an isolated neurologic finding. Here we present a case of isolated head trauma with a single physical examination finding--expressive aphasia.

Neuropsychiatric complications of traumatic brain injury

Traumatic brain injury (TBI) may be defined as any extracranial mechanical force to the brain that results in any period of loss of consciousness, any loss of memory for events immediately before or after the event, or any alteration in mental status at the time of the event. The major causes are automobile accidents, falls, sporting injuries, and assaults. Many soldiers returning from combat in Afghanistan and Iraq have also experienced TBI. This article provides an overview of the neuropsychiatric complications of TBI, including impairment of consciousness, posttraumatic amnesia, cognitive disorders and dementia, posttraumatic epilepsy, aphasia, depression, mania, psychosis, anxiety disorders, personality changes, aggression, behavioral dyscontrol, fatigue/apathy, and increased risk of suicide. Discussion will focus primarily on issues affecting mental health clinicians. Because mental health providers are more involved in care of chronic issues related to TBI, these issues will be discussed in more detail, although acute neuropsychiatric complications of TBI will be briefly explained.