Abstract：
OBJECTIVE: The case is an 88-year-old, woman, formerly a successful surgeon for decades, with Wernicke\'s aphasia due to dominant insular stroke. Our evaluation explored her deficits in the context of the heterogeneous presentations of insular strokes and how speech rehabilitation has impacted her language abilities given her cognitive reserve prior to her stroke.
METHODS: The patient sustained a left MCA embolic stroke in 2020. Neurodiagnostics revealed an infarct in the insula, dominant temporal, frontal, and parietal lobes. Baseline language assessment was completed. Results included moderate-severe receptive language impairment; intact fluency; deficits in writing and repetition; and significant paraphasias.
RESULTS: Neuropsychological assessment demonstrated prominent deficits in repetition with paraphasias and irritability. Auditory learning, attention, and working memory were invalid due to deficits in repetition. She was diagnosed with mild vascular neurocognitive disorder and conduction aphasia.
CONCLUSIONS: Despite comprehension having improved, the patient\'s paraphasias resemble the presentation of Wernicke\'s aphasia. Interestingly, there were some consistencies in paraphasic errors, such as consistently swapping certain words or letters, demonstrating diminished but not absent volition of speech. Story memory was the most effective measure of auditory memory given repetition deficits. Despite repetition deficits commonly localizing to the supramarginal gyrus, her repetition difficulty is likely related to language network disruption due to her insular infarct. Rehabilitation for comprehension was successful despite age at time of injury. Consistent with previous research, results suggest despite cognitive reserve, repetition is resistant to rehabilitation; however, in this case, paraphasic errors were also resistant. Rehabilitation should include a behavioral component for insular stroke patients.
METHODS: The patient sustained a left MCA embolic stroke in 2020. Neurodiagnostics revealed an infarct in the insula, dominant temporal, frontal, and parietal lobes. Baseline language assessment was completed. Results included moderate-severe receptive language impairment; intact fluency; deficits in writing and repetition; and significant paraphasias.
RESULTS: Neuropsychological assessment demonstrated prominent deficits in repetition with paraphasias and irritability. Auditory learning, attention, and working memory were invalid due to deficits in repetition. She was diagnosed with mild vascular neurocognitive disorder and conduction aphasia.
CONCLUSIONS: Despite comprehension having improved, the patient\'s paraphasias resemble the presentation of Wernicke\'s aphasia. Interestingly, there were some consistencies in paraphasic errors, such as consistently swapping certain words or letters, demonstrating diminished but not absent volition of speech. Story memory was the most effective measure of auditory memory given repetition deficits. Despite repetition deficits commonly localizing to the supramarginal gyrus, her repetition difficulty is likely related to language network disruption due to her insular infarct. Rehabilitation for comprehension was successful despite age at time of injury. Consistent with previous research, results suggest despite cognitive reserve, repetition is resistant to rehabilitation; however, in this case, paraphasic errors were also resistant. Rehabilitation should include a behavioral component for insular stroke patients.
摘要：
目的：这个病例88岁，女人,几十年来一直是一名成功的外科医生，Wernicke的失语症是由优势性岛状中风引起的.我们的评估探讨了她在孤立性中风的异质表现中的缺陷，以及鉴于中风前的认知储备，言语康复如何影响了她的语言能力。
方法：患者于2020年出现左MCA栓塞性卒中。神经诊断显示脑岛有梗塞,支配时间，额叶,和顶叶。基线语言评估已完成。结果包括中度至重度接受性语言障碍；完整的流畅性；写作和重复方面的缺陷；和显着的失语症。
结果：神经心理学评估显示在重复失语症和易怒方面存在显著缺陷。听觉学习,注意,工作记忆由于重复缺陷而无效。她被诊断为轻度血管神经认知障碍和传导失语。
结论：尽管理解力有所提高，患者的失语症类似于韦尼克失语症的表现。有趣的是,超相位错误有一些一致性，例如持续交换某些单词或字母，表现出减少但并非缺乏言语意志。在重复缺陷的情况下，故事记忆是听觉记忆的最有效量度。尽管重复缺陷通常位于上唇回，她的重复困难可能与她的岛屿梗塞导致的语言网络中断有关。尽管受伤时年龄较大，但理解力康复还是成功的。与以前的研究一致，结果表明，尽管认知储备，重复对康复有抵抗力；然而，在这种情况下,超相位错误也有抵抗力。康复应包括岛状中风患者的行为成分。
方法：患者于2020年出现左MCA栓塞性卒中。神经诊断显示脑岛有梗塞,支配时间，额叶,和顶叶。基线语言评估已完成。结果包括中度至重度接受性语言障碍；完整的流畅性；写作和重复方面的缺陷；和显着的失语症。
结果：神经心理学评估显示在重复失语症和易怒方面存在显著缺陷。听觉学习,注意,工作记忆由于重复缺陷而无效。她被诊断为轻度血管神经认知障碍和传导失语。
结论：尽管理解力有所提高，患者的失语症类似于韦尼克失语症的表现。有趣的是,超相位错误有一些一致性，例如持续交换某些单词或字母，表现出减少但并非缺乏言语意志。在重复缺陷的情况下，故事记忆是听觉记忆的最有效量度。尽管重复缺陷通常位于上唇回，她的重复困难可能与她的岛屿梗塞导致的语言网络中断有关。尽管受伤时年龄较大，但理解力康复还是成功的。与以前的研究一致，结果表明，尽管认知储备，重复对康复有抵抗力；然而，在这种情况下,超相位错误也有抵抗力。康复应包括岛状中风患者的行为成分。
