Based on earlier findings that the presence of word comprehension impairment (a deficit in the meaning of words, or lexical semantics) in acute stroke was strongly associated with the presence of hypoperfusion or infarct in Wernicke's area, we tested the hypothesis that the severity of word comprehension impairment was correlated with the magnitude of delay in perfusion of Wernicke's area on magnetic resonance perfusion-weighted imaging. Eighty patients were prospectively studied within 24 hours of onset or progression of acute left hemisphere stroke symptoms, with diffusion-weighted imaging, perfusion-weighted imaging, and detailed language tests. For 50 patients without infarct in Wernicke's area, we found a strong Pearson correlation between the rate of errors on a word comprehension test and the mean number of seconds of delay in time-to-peak concentration of contrast in Wernicke's area, relative to the homologous region on the right. These results add further evidence for the crucial role of Wernicke's area (Brodmann's area 22) in word comprehension and indicate that the magnitude of delay on PWI may be a gross indicator of tissue dysfunction.

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Abstract& A longitudinal study of oral and written naming and comprehension of nouns and verbs in an individual (M. M. L.) with nonfluent primary progressive aphasia (PPA) is reported. M. M. L. showed progressive deterioration of oral naming of verbs well before deterioration of written naming of verbs and before deterioration of oral or written naming of nouns. Her comprehension of both nouns and verbs remained intact, at least relative to oral naming of verbs. Her performance is compared to that of two other individuals with nonfluent PPA, who were tested at two time points. These patients showed similar patterns with respect to grammatical word class (verbs more impaired than nouns) and modality (spoken production more impaired than written production), but somewhat different courses of deterioration. The modality-specific nature of the observed verb production deficits rules out a semantic locus for the grammatical class effects. The results provide a new source of evidence for the hypothesis that there are distinct neural mechanisms for accessing lexical representations of nouns and verbs in language production. &

In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

The proposal that there are distinct neural regions devoted to the representation or processing of names of objects versus actions has received support from a variety of sources. However, there have been conflicting results regarding the localisation of the postulated mechanisms that are more crucial for one category or the other. There is also controversy as to whether the separation of mechanisms devoted to object versus action naming arises at the level of lexical-semantics or at the level of accessing lexical representations for output. We addressed these issues by testing oral naming and word comprehension of object and action names in 33 right-handed patients with acute left-hemisphere stroke, and by obtaining magnetic resonance (MR) perfusion-weighted and diffusion-weighted imaging of each patient at the same time. We identified regions of abnormal blood flow or infarction associated with impaired naming (with and without impaired word comprehension) of objects, of actions, or of both, using Fisher Exact tests. We found both neural regions shared by networks underlying naming of actions and networks underlying naming of objects, and other neural regions that were crucial to only one network or the other. One of the shared components (in the left superior temporal gyrus) was also essential to comprehension of action and object names (as tested by word/picture verification). These results converge with evidence from chronic lesion studies and functional imaging studies, indicating that some components of the neural networks for accessing lexical representations for output are more important for object names (e.g., left temporal cortex) and others more important for action names (e.g., left posterior frontal cortex).