Mixed transcortical aphasia
An aphasia is any disorder of language that causes the patient to have the inability to communicate, whether it is through writing, speaking, or sign language. Mixed transcortical aphasia is the least common of the three transcortical aphasias (behind transcortical motor aphasia and transcortical sensory aphasia, respectively). This type of aphasia can also be referred to as "Isolation Aphasia". Mixed transcortical aphasia is characterized by severe speaking and comprehension impairment, but with preserved repetition. People who suffer mixed transcortical aphasia struggle greatly to produce propositional language or to understand what is being said to them, yet they can repeat long, complex utterances or finish a song once they hear the first part. Also, naming and auditory comprehension is poor in these patients and they appear to be nonfluent. Some patients with this disorder can experience many different types neurological symptoms including, bilateral paralysis, lack of voluntary speech, and difficulty with producing spontaneous speech.
In this rare type of aphasia, Broca's area, Wernicke's area, and the arcuate fasciculus are intact but the watershed region around them is damaged. This damage isolates these areas from the rest of the brain. The most frequent etiology of mixed transcortical aphasia is stenosis (narrowing) of the internal carotid artery. Mixed transcortical aphasia can also occur after cerebral hypoxia, cerebral swelling, and any stroke that affects the cerebral artery. Often lesions that cause mixed transcortical aphasia affect both the anterior and posterior perisylvian border zones. Some times the type of aphasia can be determined just by knowing the lesion location. In order for a patient to be diagnosed with mixed transcortical aphasia all other forms of transcortical must be ruled out. Using WAB or the BDAE can rule out global aphasia if the ability to repeat is present. If verbal fluency is depressed transcortical aphasia gets ruled out and if auditory processing and comprehension is weak then it cannot be transcortical motor aphasia. If brain damage is minimal then a patient may recover language skills overtime without treatment, however if the damage is severe it may be necessary to receive speech and language therapy. Recovery from this type of brain injury is a slow process and very few patients regain the same level of language and communication skills that they have before the injury. Patients with aphasia usually undergo speech therapy where they relearn and practice supplementary communication methods. Speech therapy is not a cure for the aphasia, but instead helps patients use skills that remain intact.
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