title: A speech expression disorder in patients with severe diffuse brain injury who emerged from a vegetative or minimally conscious state.
abstract: OBJECTIVE
  The purpose of this study was to highlight a speech expression disorder considered as a mixed speech apraxia (SA) and dysarthria syndrome in patients with chronic severe diffuse brain injury (DBI) and to determine its correlation with anatomical localizations of brain lesions using neuroimaging.
  
  
  METHODS
  Among 140 patients with chronic severe DBI, eight showed this type of speech disorder. MRI (five patients) and FDG-PET (six patients) procedures were performed.
  
  
  RESULTS
  Affected patients could comprehend verbally, read words silently and express words using a word board. Compared with SA, the disorder is characterized by similarities in regards to reduced phonation and marked facio-oral apraxia, but by distinct differences in terms of an accompanying dysphagia and pyramidal/extra-pyramidal symptoms that are similar to symptoms associated with dysarthria due to pseudobulbar palsy. Diffuse regions of the white matter including the left arcuate fasciculus (AF) were significantly decreased in fractional anisotropy value. However, there was no significant cortical metabolic damage in FDG-PET.
  
  
  CONCLUSIONS
  The observed speech disorder in these patients is a characteristic entity related to dysfunction of speech expression and may be attributable to damage of not only the AF but also a number of fibres that are related to dysarthria, cognitive and emotional impairments and pyramidal/extra-pyramidal symptoms.
authors.affiliation: Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoshima
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Asano
authors.forename: Jun
authors.initials: J
authors.lastname: Shinoda
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Takenaka
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Aki
authors.forename: Toru
authors.initials: T
authors.lastname: Iwama
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D003287:Contrast Media; D056324:Diffusion Tensor Imaging; D004401:Dysarthria / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D018458:Persistent Vegetative State / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D049268:Positron-Emission Tomography / Q000379:methods; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D019788:Fluorodeoxyglucose F18