Objective

We studied an unusual case of global aphasia (GA) occurring after brain tumor removal and remitting one-month after surgery. After recovering, the patient reported on her experience during the episode, which suggested a partial preservation of language abilities (such as semantic processing) and the presence of inner speech (IS) despite a failure in overt speech production. Thus, we explored the role of IS and preserved language functions in the acute phase and investigated the neuroanatomical underpinnings of this severe breakdown in language processing.

Method

A neuropsychological and language assessment tapping into language production, comprehension, attention and working memory was carried out both before and three months after surgery. In the acute stage a simplified protocol was tailored to assess the limited language abilities and further explore patient's performance on different semantic tasks. The neuroanatomical dimension of these abrupt changes was provided by perioperative structural neuroimaging.

Results

Language and neuropsychological performance were normal/close to normal both before and three months after surgery. In the acute stage, the patient presented severe difficulties with comprehension, production and repetition, whereas she was able to correctly perform tasks that requested conceptual analysis and non-verbal operations. After recovering, the patient reported that she had been able to internally formulate her thoughts despite her overt phonological errors during the episode. Structural neuroimaging revealed that an extra-axial blood collection affected the middle frontal areas during the acute stage and that the white matter circuitry was left-lateralized before surgery.

Conclusions

We deemed that the global aphasia episode was produced by a combination of the post-operative extra-axial blood collection directly impacting left middle frontal areas and a left-lateralization of the arcuate and/or uncinated fasciculi before surgery. Additionally, we advocate for a comprehensive evaluation of linguistic function that includes the assessment of IS and non-expressive language functions in similar cases.

中文翻译：

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全球失语症的黑匣子：保留了内部语言功能的急性全局失语症缓解的神经解剖学基础。

目的

我们研究了脑瘤切除术后一个月出现的一种罕见的全球失语症（GA）病例。康复后，患者报告了发作期间的经历，这表明语言能力（例如语义处理）和内部语音（IS）的存在得以部分保留，尽管公开语音输出失败。因此，我们探索了IS在急性期中的作用和保留的语言功能，并研究了语言处理中这种严重崩溃的神经解剖学基础。

方法

在手术前和术后三个月进行了神经心理学和语言评估，以评估语言的产生，理解，注意力和工作记忆。在急性期，量身定制的简化协议可以评估有限的语言能力，并进一步探讨患者在不同语义任务上的表现。这些突然改变的神经解剖学维度是由围手术期结构神经成像提供的。

结果

术前和术后三个月的语言和神经心理表现均正常/接近正常。在急性期，患者在理解，产生和重复方面表现出严重困难，而她能够正确执行要求进行概念分析和非语言操作的任务。康复后，患者报告尽管发作期间明显的语音错误，但她仍能够内部表达自己的想法。结构神经影像学检查显示，在急性期，轴外血液采集影响了额中部区域，并且在手术前白质回路被偏左。

结论

我们认为，总体失语症是由术后直接影响左中额额叶区域的术后轴向外血液采集以及术前弓形和/或未接种的束状肌的左偏侧化所引起的。此外，我们主张对语言功能进行全面评估，包括在类似情况下评估IS和非表达性语言功能。