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Neurosurg Focus. 2013 Apr;34(4):E6. doi: 10.3171/2013.2.FOCUS12413.

Association of functional magnetic resonance imaging indices with postoperative language outcomes in patients with primary brain tumors.
Kundu B, Penwarden A, Wood JM, Gallagher TA, Andreoli MJ, Voss J, Meier T, Nair VA, Kuo JS, Field AS, Moritz C, Meyerand ME, Prabhakaran V.

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OBJECT: Functional MRI (fMRI) has the potential to be a useful presurgical planning tool to treat patients with primary brain tumor. In this study the authors retrospectively explored relationships between language-related postoperative outcomes in such patients and multiple factors, including measures estimated from task fMRI maps (proximity of lesion to functional activation area, or lesion-to-activation distance [LAD], and activation-based language lateralization, or lateralization index [LI]) used in the clinical setting for presurgical planning, as well as other factors such as patient age, patient sex, tumor grade, and tumor volume. METHODS: Patient information was drawn from a database of patients with brain tumors who had undergone preoperative fMRI-based language mapping of the Broca and Wernicke areas. Patients had performed a battery of tasks, including word-generation tasks and a text-versus-symbols reading task, as part of a clinical fMRI protocol. Individually thresholded task fMRI activation maps had been provided for use in the clinical setting. These clinical imaging maps were used to retrospectively estimate LAD and LI for the Broca and Wernicke areas. RESULTS: There was a relationship between postoperative language deficits and the proximity between tumor and Broca area activation (the LAD estimate), where shorter LADs were related to the presence of postoperative aphasia. Stratification by tumor location further showed that for posterior tumors within the temporal and parietal lobes, more bilaterally oriented Broca area activation (LI estimate close to 0) and a shorter Wernicke area LAD were associated with increased postoperative aphasia. Furthermore, decreasing LAD was related to decreasing LI for

both Broca and Wernicke areas. Preoperative deficits were related to increasing patient age and a shorter Wernicke area LAD. CONCLUSIONS: Overall, LAD and LI, as determined using fMRI in the context of these paradigms, may be useful indicators of postsurgical outcomes. Whereas tumor location may influence postoperative deficits, the results indicated that tumor proximity to an activation area might also interact with how the language network is affected as a whole by the lesion. Although the derivation of LI must be further validated in individual patients by using spatially specific statistical methods, the current results indicated that fMRI is a useful tool for predicting postoperative outcomes in patients with a single brain tumor. Neurosurg Focus. 2013 Apr;34(4):E7. doi: 10.3171/2013.2.FOCUS12410.

The role of secondary motor and language cortices in morbidity and mortality: a retrospective functional MRI study of surgical planning for patients with intracranial tumors.
Voss J, Meier TB, Freidel R, Kundu B, Nair VA, Holdsworth R, Kuo JS, Prabhakaran V.

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OBJECT: Functional MRI (fMRI) is commonly used by neurosurgeons preoperatively to identify brain regions associated with essential behaviors, such as language and motor abilities. In this study the authors investigated the relationship between patient morbidity and mortality and the distance from the tumor border area to functional activations in secondary motor and language cortices. METHODS: Patients with primary or metastatic brain tumors who underwent preoperative fMRI motor and language mapping were selected from a large database of patients with tumors. The lesion-toactivation distance (LAD) was measured in each patient relative to the supplementary motor area (SMA) for motor tasks and the presupplementary motor area (pSMA) for language tasks. The association between LAD and the incidence of deficits was investigated using the Fisher exact

tests of significance. The impact of other variables, including age, handedness, sex, and tumor grade, was also investigated. In a subset of patients, logistic regression was performed to identify the likelihood of deficits based on the LAD to primary and secondary regions. Finally, MantelCox log-rank tests were performed to determine whether survival time was significantly related to the LAD to secondary motor and language areas. RESULTS: A significant association was observed between the LAD to the SMA and the incidence of motor deficits, with the percentage of patients with deficits dropping for those in the LAD > 2 cm group. The relationship between the LAD to the pSMA and the incidence of language deficits was not significant. Logistic regression demonstrated that the LAD to primary sensorimotor cortex does affect the incidence of motor deficits, but that the LAD to SMA does not. Finally, the authors observed no relationship between the LAD to secondary regions and patient mortality rates. CONCLUSIONS: These results demonstrate that the LAD to SMA structures does affect morbidity, although not to the extent of LAD to primary structures. In addition, motor deficits are significantly associated with LAD to secondary structures, but language deficits are not. This should be considered by neurosurgeons for patient consultation and preoperative planning. PMID: 23544413 [PubMed - indexed for MEDLINE] PMCID: PMC3817821 Free PMC Article Pediatr Blood Cancer. 2008 Mar;50(3):706-8.

Speech-language and hearing complaints of children and adolescents with brain tumors.
Gonalves MI, Radzinsky TC, da Silva NS, Chiari BM, Consonni D.

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Central nervous system (CNS) tumors generally leave sequelae that may compromise speech, language, swallowing, hearing, and voice functions. This report describes the incidence of

speech-language and hearing complaints and disorders in children and adolescents with CNS tumor under treatment at one of the most important Brazilian reference center for pediatric cancer. One-hundred ninety patients were examined for speech-pathology screening and analysis: forty-two percent presented with complaints and symptoms. From the remaining patients, 68% presented clinical symptoms and 32% were actually free from any speechlanguage and hearing-related symptoms. The high incidence of complaints and symptoms indicate that these patients might benefit from specific rehabilitation interventions. (c) 2007 Wiley-Liss, Inc. NeuroRehabilitation. 2005;20(2):107-24.

Language outcomes subsequent to treatment of brainstem tumour in childhood.

Docking KM, Ward EC, Murdoch BE.

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While the occurrence and management of brainstem tumours in children would not traditionally indicate potential direct structural impact on classical language centres, recent theories have implicated some involvement of the brainstem in a functional language and cognitive neural loop between the cerebellum and the cerebral hemispheres. Thus, the present paper explored the impact of treatment for brainstem tumour on the general and high-level language abilities of six children treated for brainstem tumour, in addition to phonological awareness skills. Group analysis revealed that children treated for brainstem tumour demonstrated intact language and phonological awareness abilities in comparison to an age- and gender-matched control group. Individual analysis revealed only one of six children treated for brainstem tumour revealed evidence of language disturbances, with an additional child demonstrating an isolated mildly reduced score on one phonological awareness task. Language deficits identified in a child treated with a combination of both radiotherapy and chemotherapy were noted in the high-level language area of lexical generation. Findings highlighted that no overt language disturbances were evident in children treated for brainstem tumour. However, further analysis into higherlevel language skills in the present study indicated that both general and high-level language abilities require long-term monitoring in this population. PMID: 15920303 [PubMed - indexed for MEDLINE] Eur J Paediatr Neurol. 2012 Sep;16(5):434-42. doi: 10.1016/j.ejpn.2011.12.013. Epub 2012 Jan 18.

Auditory-perceptual speech analysis in children with cerebellar tumours: a longterm follow-up study.
De Smet HJ, Catsman-Berrevoets C, Aarsen F, Verhoeven J, Marin P, Paquier PF.

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Mutism and Subsequent Dysarthria (MSD) and the Posterior Fossa Syndrome (PFS) have become well-recognized clinical entities which may develop after resection of cerebellar tumours. However, speech characteristics following a period of mutism have not been documented in much detail. This study carried out a perceptual speech analysis in 24 children and adolescents (of whom 12 became mute in the immediate postoperative phase) 1-12.2 years after cerebellar tumour resection. The most prominent speech deficits in this study were distorted vowels, slow rate, voice tremor, and monopitch. Factors influencing long-term speech disturbances are presence or absence of postoperative PFS, the localisation of the surgical lesion and the type of adjuvant treatment. Long-term speech deficits may be present up to 12 years post-surgery. The speech deficits found in children and adolescents with cerebellar lesions following cerebellar tumour surgery do not necessarily resemble adult speech characteristics of ataxic dysarthria. Copyright 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. J Neurol Neurosurg Psychiatry. 1999 Dec;67(6):755-7.

Tumour type and size are high risk factors for the syndrome of "cerebellar" mutism and subsequent dysarthria.
Catsman-Berrevoets CE, Van Dongen HR, Mulder PG, Paz y Geuze D, Paquier PF, Lequin MH.

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"Cerebellar mutis" and subsequent dysarthria (MSD) is a documented complication of posterior fossa surgery in children. In this prospective study the following risk factors for MSD were assessed: type, size and site of the tumour; hydrocephalus at presentation and after surgery, cerebellar incision site, postoperative infection, and cerebellar swelling. METHODS: In a consecutive series of 42 children with a cerebellar tumour, speech and neuroradiological studies (CT and MRI) were systematically analysed preoperatively and postoperatively. Speech was assessed using the Mayo Clinic lists and the severity of dysarthria using the Michigan rating scale. RESULTS: Twelve children (29%) developed MSD postoperatively. The type of tumour, midline localisation, and vermal incision were significant single independent risk factors. In addition, an interdependency of possible risk factors (tumour>5 cm, medulloblastoma) was found. CONCLUSION: MSD often occurs after paediatric cerebellar tumour removal and is most likely after removal of a medulloblastoma with a maximum lesion diameter>5 cm. PMID: 10567492 [PubMed - indexed for MEDLINE] PMCID: PMC1736675 Free PMC Article Acta Neurochir (Wien). 1994;131(1-2):74-9.

Transient mutism and speech disorders after posterior fossa surgery in children with brain tumours.
Kingma A, Mooij JJ, Metzemaekers JD, Leeuw JA.

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Four patients aged 5 to 9 years with large tumours located in the posterior fossa (PNET, ependymoma or astrocytoma) are presented. Patients received standard neuropsychological assessments, including speech evaluation, prior to surgery. Following tumour resection, these 4 children developed transient mutism or different types of speech and cognitive disorders, associated with behavioural disturbances. We describe course and results of repeated postoperative neurological and neuropsychological evaluations. Full recovery of speech was seen in 3 out of 4 patients; the only child with persistent symptoms was the one who already had neuropsychological deficits before surgery. However, despite fast recovery of the speech disorders more persistent behavioural problems were found in 3 out of 4 patients. Possible pathogenesis anatomical location of this "cerebellar speech syndrome" are discussed, as well as the relevance of repeated neuropsychological assessments. Funct Neurol. 2013 Jan-Mar;28(1):55-61.

Atypical language lateralization: an fMRI study in patients with cerebral lesions.

Fakhri M, Oghabian MA, Vedaei F, Zandieh A, Masoom N, Sharifi G, Ghodsi M, Firouznia K.

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Differences in the lateralization of language processes between healthy subjects and patients with neurological complaints other than epilepsy have been less documented than those between healthy subjects and epilepsy patients. Moreover, the contribution of factors such as the location and type of lesion in determining interhemispheric shift of language function is poorly understood. Sixty-seven patients who underwent presurgical evaluations at the Medical Imaging Center of the Imam Khomeini University Hospital, Tehran, and the same number of healthy controls, were recruited. The laterality index (LI) of language activation, calculated from two separate functional magnetic resonance imaging tasks, was compared between the patients and the age-/gender-/handedness-matched controls. Chi square testing showed that the percentages of subjects with "typical" and "atypical" language dominance in the patient group were significantly different from the percentages recorded in the matched healthy controls for both tasks (p<0.005). Lesion type, lesion location, lesion hemisphere, presenting symptom and patient gender had no statistically significant effect on the hemispheric LI (p>0.05). In a logistic regression model including all potential determinants of atypical LI, age emerged as the only independent predictor (p<0.05, odds ratio=0.9). Abnormal language lateralization is found in patients with a variety of cerebral lesions and with a diversity of clinical manifestations. In our selected population, symptom duration, lesion hemisphere and anatomical site of the lesion were not found to impact significantly on the development of an abnormal LI while patient age can independently predict the presence of an atypical LI. PMID:

23731916 [PubMed - indexed for MEDLINE] PMCID: PMC3812717 Free PMC Article Brain Lang. 2011 May;117(2):69-76. doi: 10.1016/j.bandl.2011.01.002. Epub 2011 Feb 21.

Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour.
Morgan AT, Ligeois F, Liederkerke C, Vogel AP, Hayward R, Harkness W, Chong K, VarghaKhadem F.

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Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen long-term after surgical treatment for childhood PFT, unselected for the presence of post-operative mutism (mean time postsurgery=6y10m, range 1;4-12;6 years, two had post-operative mutism), and examine factors affecting outcome. Twenty-six age- and sex- matched healthy controls were recruited for comparison. Participants in both groups had speech assessments using detailed perceptual and acoustic methods. Over two-thirds of the group (69%) with removal of PFT had a profile of typically mild dysarthria. Prominent speech deficits included consonant imprecision, reduced rate, monopitch and monoloudness. We conclude that speech deficits may persist even up to 10 years post-surgery in participants who have not shown mutism in the acute phase. Of cases with unilateral lesions, poorer outcomes were associated with right cerebellar tumours compared to left, consistent with the notion based on adult data that speech is controlled by reciprocal right cerebellar/left frontal interactions. These results confirm the important role of the cerebellum in the control of fine speech movements in children. 2011. Published by Elsevier Inc. All rights reserved. Neurocase. 2009 Aug;15(4):294-310. doi: 10.1080/13554790902729473. Epub 2009 Mar 9.

Speaking without Broca's area after tumor resection.

Plaza M, Gatignol P, Leroy M, Duffau H.

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We present the case of a right-handed patient who received surgical treatment for a left frontal WHO grade II glioma invading the left inferior and middle frontal gyri, the head of the caudate nucleus, the anterior limb of the internal capsule and the anterior insula, in direct contact also with the anterior-superior part of the lentiform nucleus. The tumor resection was guided by direct electrical stimulation on brain areas, while the patient was awake. Adding a narrative production task to the neuropsychological assessment, we compared pre-, peri- and post-surgical language skills in order to analyze the effects of the tumor infiltration and the consequences of the left IFG resection, an area known to be involved in various language and cognitive processes. We showed that the tumor infiltration and its resection did not lead to the severe impairments predicted by the localization models assigning a significant role in language processing to the left frontal lobe, notably Broca's area. We showed that slow tumor evolution - the patient had been symptom-free for a long time - enabled compensatory mechanisms to process most language functions endangered by the tumor infiltration. However, a subtle fragility was observed in two language devices, i.e., reported speech and relative clauses, related to minor working memory deficits. This case study of a patient speaking without Broca's area illustrates the efficiency of brain plasticity, and shows the necessity to broaden pre-, peri-, post-surgery language and cognitive assessments. J Neurosurg Pediatr. 2013 Dec;12(6):604-14. doi: 10.3171/2013.8.PEDS13168. Epub 2013 Sep 27.

Cerebellar mutism.
Pitsika M, Tsitouras V.

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Mutism of cerebellar origin is a well-described clinical entity that complicates operations for posterior fossa tumors, especially in children. This review focuses on the current understanding of principal pathophysiological aspects and risk factors, epidemiology, clinical characteristics, treatment strategies, and outcome considerations. The PubMed database was searched using the term cerebellar mutism and relevant definitions to identify publications in the English-language

literature. Pertinent publications were selected from the reference lists of the previously identified articles. Over the last few years an increasing number of prospective studies and reviews have provided valuable information regarding the cerebellar mutism syndrome. Importantly, the clarification of principal terminology that surrounds the wide clinical spectrum of the syndrome results in more focused research and more effective identification of this entity. In children who undergo surgery for medulloblastoma the incidence of cerebellar mutism syndrome was reported to be 24%, and significant risk factors so far are brainstem involvement and midline location of the tumor. The dentate-thalamo-cortical tracts and lesions that affect their integrity are considered significant pathophysiological issues, especially the tract that originates in the right cerebellar hemisphere. Moderate and severe forms of the cerebellar mutism syndrome are the most frequent types during the initial presentation, and the overall neurocognitive outcome is not as favorable as thought in the earlier publications. Advanced neuroimaging techniques could contribute to identification of high-risk patients preoperatively and allow for more effective surgical planning that should focus on maximal tumor resection with minimal risk to important neural structures. Properly designed multicenter trials are needed to provide stronger evidence regarding effective prevention of cerebellar mutism and the best therapeutic approaches for such patients with a combination of pharmacological agents and multidisciplinary speech and behavior augmentation. Cerebellum. 2011 Sep;10(3):551-62. doi: 10.1007/s12311-011-0273-2.

Heralding cerebellar mutism: evidence for pre-surgical language impairment as primary risk factor in posterior fossa surgery.
Di Rocco C, Chieffo D, Frassanito P, Caldarelli M, Massimi L, Tamburrini G.

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The aim of this study is to identify possible risks factors for the occurrence of cerebellar mutism syndrome (CMS) in children with posterior cranial fossa tumours. Children diagnosed with posterior fossa tumours consecutively admitted to our institution between 2006 and 2008 were the subjects of this prospective study. Besides standard neurological and radiological evaluations, all children underwent thorough neuropsychological assessments at admission and following surgery. Children under two or older than 16 years of age and those with a severe preoperative clinical condition precluding neuropsychological assessment were excluded. Thirtyfour children met the inclusion criteria. They were divided into two groups. Group I consisted of 23 children with normal language on admission and group II had 11 children showing preoperative language impairment (PLI). PLI was observed in 11 children (32.4%: group II). Postoperatively, seven out of 34 children developed CMS (20.6%), all of them belonging to group II. In group II, indeed, the incidence of CMS was 63%. No case of CMS was observed in group I.

PLI regressed after the operation in three out of the four subjects belonging to group II who did not develop CMS. PLI remained unchanged in the last child of this group. Posterior fossa tumour resection can have different effects on children with pre-existing language impairment (PLI). PLI can be considered a subclinical state of CMS in some children with posterior fossa tumour. However, in some children with PLI, the tumour resection may improve the linguistic abilities, as well as the other neurocognitive performances. In the present series, children with normal preoperative language function did not develop post-operative mutism. PMID: 21476131 [PubMed - indexed for MEDLINE] Neuro Oncol. 2012 Oct;14(10):1294-303. Epub 2012 Sep 5.

Clinical and neuroanatomical predictors of cerebellar mutism syndrome.

Law N, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Strother D, Fryer C, McConnell D, Hukin J, Kaise C, Wang F, Mabbott DJ.

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Cerebellar mutism syndrome (CMS) is an important medical challenge in the management of pediatric posterior fossa brain tumors, because it occurs in a subset of children following tumor resection. A definitive clinical profile and neuroanatomical substrate associated with CMS remains unclear. We investigated the relationship between presurgical and clinical variables and the incidence of CMS, along with diffusion tensor imaging, to characterize the integrity of cerebello-thalamo-cerebral white matter pathways. Seventeen children with posterior fossa tumors and CMS, 34 children with posterior fossa tumors without CMS, and 28 healthy children were enrolled in this study. Bilateral cerebello-thalamo-cerebral pathways were delineated and segmented into anatomical regions. Mean integrity measures for each region were compared among children with CMS, children without CMS, and healthy children. Left-handedness, medulloblastoma histology, and larger tumor size distinguished between patients with CMS and patients without CMS (P < .04). Right cerebellar white matter within the cerebello-thalamocerebral pathway was compromised in children with CMS relative to children without CMS and healthy children (P < .02). We provide a potential schema for CMS risk among children treated for posterior fossa tumors. Left-handed children treated for medulloblastoma may be the most at risk for CMS, and unilateral, localized damage within the cerebello-thalamo-cerebral pathway at the level of the right cerebellum is implicated in the presentation of CMS. This disruption in communication between the right cerebellum and left frontal cortex may contribute to speechlanguage problems observed in children with CMS. Our findings may be relevant for surgical planning and speech-language therapy to mitigate symptoms of CMS.

PMID: 22952198 [PubMed - indexed for MEDLINE] PMCID: PMC3452341 Free PMC Article Cortex. 2012 Feb;48(2):255-72. doi: 10.1016/j.cortex.2011.11.015. Epub 2011 Dec 7.

Aphasia induced by gliomas growing in the ventrolateral frontal region: assessment with diffusion MR tractography, functional MR imaging and neuropsychology.
Bizzi A, Nava S, Ferr F, Castelli G, Aquino D, Ciaraffa F, Broggi G, DiMeco F, Piacentini S.

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INTRODUCTION: Lesions in the ventrolateral region of the dominant frontal lobe have been historically associated with aphasia. Recent imaging results suggest that frontal language regions extend beyond classically defined Broca's area to include the ventral precentral gyrus (VPCG) and the arcuate fasciculus (AF). Frontal gliomas offer a unique opportunity to identify structures that are essential for speech production. The aim of this prospective study was to investigate the correlation between language deficits and lesion location in patients with gliomas. METHODS: Nineteen patients with glioma and 10 healthy subjects were evaluated with diffusion tensor imaging magnetic resonance (MR) tractography, functional MR (verb generation task) and the Aachener Aphasie Test. Patients were divided into two groups according to lesion location with respect to the ventral precentral sulcus: (i) anterior (n=8) with glioma growing in the inferior frontal gyrus (IFG) and underlying white matter; (ii) posterior (n=11) with glioma growing in the VPCG and underlying white matter. Virtual dissection of the AF, frontal intralobar tract, uncinate fasciculus (UF) and inferior frontal occipital fasciculus (IFOF) was performed with a deterministic approach. RESULTS:

Seven posterior patients showed aphasia classified as conduction (4), Broca (1), transcortical motor (1) and an isolated deficit of semantic fluency; one anterior patient had transcortical mixed aphasia. All posterior patients had invasion of the VPCG, however only patients with aphasia had also lesion extension to the AF as demonstrated by tractography dissections. All patients with language deficits had high grade glioma. Groups did not differ regarding tumour volume. A functional pars opercularis was identified with functional MR imaging (fMRI) in 17 patients. CONCLUSIONS: Gliomas growing in the left VPCG are much more likely to cause speech deficits than gliomas infiltrating the IFG, including Broca's area. Lesion extension to the AF connecting frontal to parietal and temporal regions is an important mechanism for the appearance of aphasia. Copyright 2011 Elsevier Srl. All rights reserved. Brain. 2013 Nov;136(Pt 11):3451-60. doi: 10.1093/brain/awt267. Epub 2013 Oct 15.

Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia.
Fridriksson J, Guo D, Fillmore P, Holland A, Rorden C.

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Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe

with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia, the two most common kinds of non-fluent aphasia. In summary, the current results suggest that the anterior segment of the left arcuate fasciculus, a white matter tract that lies deep to posterior portions of Broca's area and the sensory-motor cortex, is a robust predictor of impaired speech fluency in aphasic patients, even when motor speech, lexical processing, and executive functioning are included as co-factors. Simply put, damage to those regions results in non-fluent aphasic speech; when they are undamaged, fluent aphasias result. Brain. 2009 Sep;132(Pt 9):2309-16. doi: 10.1093/brain/awp206. Epub 2009 Aug 18.

The role of the arcuate fasciculus in conduction aphasia.

Bernal B, Ardila A.

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In aphasia literature, it has been considered that a speech repetition defect represents the main constituent of conduction aphasia. Conduction aphasia has frequently been interpreted as a language impairment due to lesions of the arcuate fasciculus (AF) that disconnect receptive language areas from expressive ones. Modern neuroradiological studies suggest that the AF connects posterior receptive areas with premotor/motor areas, and not with Broca's area. Some clinical and neurophysiological findings challenge the role of the AF in language transferring. Unusual cases of inter-hemispheric dissociation of language lateralization (e.g. Broca's area in the left, and Wernicke's area in the right hemisphere) have been reported without evident repetition defects; electrocortical studies have found that the AF not only transmits information from temporal to frontal areas, but also in the opposite direction; transferring of speech information from the temporal to the frontal lobe utilizes two different streams and conduction aphasia can be found in cases of cortical damage without subcortical extension. Taken altogether, these findings may suggest that the AF is not required for repetition although could have a subsidiary role in it. A new language network model is proposed, emphasizing that the AF connects posterior brain areas with Broca's area via a relay station in the premotor/motor areas. J Child Neurol. 2007 Jul;22(7):848-54.

Long-term neuromotor speech deficits in survivors of childhood posterior fossa tumors: effects of tumor type, radiation, age at diagnosis, and survival years.
Huber JF, Bradley K, Spiegler B, Dennis M.

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The cerebellum is important for the coordination of fluent speech. The authors studied how childhood cerebellar tumors affect long-term neuromotor speech outcomes, including the relation between outcome and tumor type, radiation, age at diagnosis, and survival years. Videotaped speech samples of child and adult long-term survivors of childhood cerebellar astrocytoma (nonradiated) and medulloblastoma (radiated) tumors and healthy controls were analyzed by 2 speech pathologists for ataxic dysarthria, dysfluency, and speech rate. Ataxia varied with tumor type/radiation. Medulloblastoma survivors had significantly more ataxic dysarthric features than either survivors of astrocytomas or controls, who did not differ from each other. Dysfluency varied with a history of a posterior fossa tumor. Medulloblastoma and astrocytoma survivors were each significantly more dysfluent than controls but did not differ from each other. Speech rate varied with age and tumor type. Adult controls were significantly faster than child controls, although adult tumor survivors were comparable to their child counterparts. Adult controls had significantly faster speech rates than adult survivors of medulloblastoma tumors. Ataxic dysarthric speech characteristics are more frequent in radiated survivors of medulloblastoma tumors than nonradiated survivors of astrocytoma tumors. Dysfluent and slow speech occur in cerebellar tumor survivors, regardless of tumor type and radiation history. Cerebellar tumors in childhood limit speech rate in adulthood. J Clin Exp Neuropsychol. 2010 Apr;32(4):417-32. doi: 10.1080/13803390903164355.

Language disorders in children with central nervous system injury.

Dennis M.

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Children with injury to the central nervous system (CNS) exhibit a variety of language disorders that have been described by members of different disciplines, in different journals, using different descriptors and taxonomies. This paper is an overview of language deficits in children with CNS injury, whether congenital or acquired after a period of normal development. It first reviews the principal CNS conditions associated with language disorders in childhood. It then describes a functional taxonomy of language, with examples of the phenomenology and neurobiology of clinical deficits in children with CNS insults. Finally, it attempts to situate language in the broader realm of cognition and in current theoretical accounts of embodied cognition Pediatr Neurol. 1998 May;18(5):411-4.

Dysarthria in children with cerebellar or brainstem tumors.

van Mourik M, Catsman-Berrevoets CE, Yousef-Bak E, Paquier PF, van Dongen HR.

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Speech features were perceptually analyzed in two groups of children. The first group (n = 6) had undergone cerebellar tumor resection, and the second group (n = 6) included children with brainstem tumors. Children belonging to the first group became dysarthric after a postoperative mute phase. Slow speech rate was a specific feature, but scanning speech and irregular articulatory breakdown (i.e., prominent characteristics in adult ataxic dysarthria) were not observed. In the second group, hypernasality was a prominent characteristic and resembled flaccid dysarthria in adults. These findings suggest that acquired childhood dysarthria needs a proper classification. Brain Lang. 2002 Mar;80(3):592-602.

Neuromotor speech deficits in children and adults with spina bifida and hydrocephalus.
Huber-Okrainec J, Dennis M, Brettschneider J, Spiegler BJ.

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Acquired cerebellar lesions are associated with motor speech deficits. Spina bifida with hydrocephalus (SBH) is a neurodevelopmental disorder that involves significant dysmorphology of the cerebellum. Videotaped narratives produced by 40 children and adults with SBH and their 40 age-matched controls were coded for three motor speech deficits: dysfluency, ataxic dysarthria (articulatory inaccuracy, prosodic excess, and phonatory-prosodic insufficiency) (Brown, Darley, & Aronson, 1970; Darley, Aronson, & Brown, 1969a), and speech rate. Individuals with SBH had more motor speech deficits than controls. Dysfluency was related to an interaction between chronological age and SBH. Speech rate was related independently to chronological age and SBH. Ataxic dysarthria was related to the biology of SBH, and was associated with both physical phenotype (level of spinal cord lesion) and medical history (number of shunt revisions). The data show that developmental as well as acquired lesions of the cerebellum disrupt motor speech, and add to the developmental role of the cerebellum in the automatization of motor skills, including speech. Copyright 2002 Elsevier Science (USA). Cerebellum. 2007;6(1):58-65.

The neural basis of ataxic dysarthria.

Spencer KA, Slocomb DL.

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Lesions to the cerebellum often give rise to ataxic dysarthria which is characterized by a primary disruption to articulation and prosody. Converging evidence supports the likelihood of speech motor programming abnormalities in addition to speech execution deficits. The understanding of ataxic dysarthria has been further refined by the development of neural network models and neuroimaging studies. A critical role of feedforward processing by the cerebellum has been established and linked to speech motor control and to aspects of ataxic dysarthria. Moreover, this research has helped to define models of the cerebellar contributions to speech processing and production, and to posit possible regions of speech localization within the cerebellum. Bilateral, superior areas of the cerebellum appear to mediate speech motor control while a putative role of the right cerebellar hemispheres in the planning and processing of speech has been suggested.

Incidence of mutism, dysarthria and dysphagia associated with childhood posterior fossa tumour.
Cristina Mei, Angela T Morgan

Healthy Development Theme, Murdoch Childrens Research Institute, Parkville, 3052, Melbourne, Australia. Child s Nervous System (Impact Factor: 1.24). 03/2011; 27(7):1129-36. DOI:10.1007/s00381011-1433-x Source: PubMed ABSTRACT Dysarthria and dysphagia are known complications following posterior fossa tumour (PFT) surgery. Outcome studies for these disorders, however, have focused on a select sub-group of children with mutism. Little is known regarding the incidence or features of these impairments in a consecutively admitted sample of children with PFT. This study describes the incidence and features of mutism, dysarthria and dysphagia during the acute post-surgical phase in a consecutive sample of children with PFT, unselected for the presence of mutism. A retrospective medical chart review of children aged 2 to 18 years consecutively admitted with PFT between January 2003 and January 2008 was conducted. Twenty-seven children with PFT were identified. Post-surgical mutism, dysarthria and dysphagia were recorded in 9/27 (33%), 8/27 (30%) and 9/27 (33%) cases, respectively. Dysarthria most commonly involved deficits in articulation; however, impairments in respiration, phonation and prosody were also reported. Dysphagia involved all stages of swallowing (i.e., pre-oral anticipatory, oral preparatory, oral and pharyngeal). Eighty-nine percent of children (8/9) presented with dysphagia at hospital discharge. The incidence of acute presentation of mutism, dysarthria and dysphagia post-surgery was relatively high, affecting around one in three cases. This incidence rate, considered together with the fact that over half of all cases had co-morbid communication or swallowing impairments, suggests that health professionals should be aware of the likelihood of dysarthria and dysphagia presentation in the acute period and consider speech pathology referral where necessary.
Brain Lang. 2001 Dec;79(3):580-600.

The lateralized linguistic cerebellum: a review and a new hypothesis.

Marien P, Engelborghs S, Fabbro F, De Deyn PP.

Author information Abstract

During the past 2 decades the collaboration across disciplines and the methodologic and conceptual advances of contemporary neuroscience have brought about a substantial modification of the traditional view of the cerebellum as a mere coordinator of autonomic and somatic motor functions. Growing insights in the neuroanatomy of the cerebellum and its interconnections, evidence from functional neuroimaging and neurophysiological research, and advancements in clinical and experimental neuropsychology have established the view that the cerebellum participates in a much wider range of functions than conventionally accepted. This

increase of insight has brought to the fore that the cerebellum modulates cognitive functioning of at least those parts of the brain to which it is reciprocally connected. This article reviews the recently acknowledged role of the cerebellum in cognition and addresses in more detail experimental and clinical data disclosing the modulatory role of the cerebellum in various nonmotor language processes such as lexical retrieval, syntax, and language dynamics. In agreement with the findings indicating a topographical organization of the cerebellar structures involved in language pathology we advance the concept of a "lateralized linguistic cerebellum." In our view crossed cerebral diaschisis processes, reflecting a functional depression of supratentorial language areas due to reduced input via cerebellocortical pathways, might represent the relevant pathomechanism for linguistic deficits associated with cerebellar pathology.