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Aphasia has also been described frequently with dominant striatocapsular lesions, particularly if they extend laterally into the subcortical white matter of the temporal lobe and insula The head of the caudate, anterior limb of the internal capsule, or the anterosuperior aspect of the putamen are the structures involved in different patients The aphasia is characterized by non uent, dysarthric, paraphasic speech and varying degrees of dif culty with comprehension of language, naming, and repetition The lesion is vascular as a rule, and a right hemiparesis is usually associated In general, striatocapsular aphasia recovers more slowly and less completely than thalamic aphasia These two subcortical aphasias thalamic and striatocapsular resemble but are not identical to the Wernicke and Broca types of aphasia For further discussion, the reader is directed to the articles of Naeser and of Alexander and their colleagues

Five different chart types are included in the Web screens at the top of the dashboard Assuming that the developer is able to get all of them to work appropriately, we encounter issues with spacing The descriptions are not clear enough for us to understand what all the colors mean, and because there s not enough space, the titles have been reduced to being so small that we would have to have worked with this information over time to understand what each indicator is trying to tell us Remember, you have a total of three to four minutes of the CEO s time to deliver the information needed to make decisions, so make the most of that time This dashboard is too overloaded too much information all at once, too detailed, and no central focus to the primary KPI that the developer is trying to communicate to the business user

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It would be incorrect to conclude that the syndromes described above, all of which are related to perisylvian lesions of the dominant cerebral hemisphere, represent all the ways in which cerebral disease disturbs language The effects on speech and language of diffuse cerebral disorders, such as delirium tremens and Alzheimer disease, have already been mentioned (see pages 364 and 417) Pathologic changes in parts of the cerebrum other than the perisylvian regions may secondarily affect language function The lesions that occur in the border zones between major cerebral arteries and effectively isolate perisylvian areas from other parts of the cerebrum fall into this category (transcortical aphasias, see above) Other examples are the lesions in the medio-orbital or superior and lateral parts of the frontal lobes, which impair all motor activity, to the point of abulia or akinetic mutism (page 359) The mute patient, in contrast to the aphasic one, emits no sounds If the patient is less severely hypokinetic, his speech tends to be laconic, with long pauses and an inability to sustain a monologue Extensive occipital lesions will, of course, impair reading, but they also reduce the utilization of all visual and lexical stimuli Deep cerebral lesions, by causing uctuating states of inattention and disorientation, induce fragmentation of words and phrases and sometimes protracted, uncontrollable talking (logorrhea) Also common in global or multifocal cerebral diseases are defects in prosody, both expressive and receptive These appear in numerous states that affect global cerebral function, such as Alzheimer disease as well as with lesions of the nondominant (right) perisylvian region as noted in Chap 22 Severe mental retardation often results in failure to acquire even spoken language, as pointed out in Chaps 28 and 38 If there is any language skill, it consists only of the understanding of a few simple spoken commands The subject of developmental dyslexia is discussed on page 510.

Subcortical Aphasia (Thalamic and Striatocapsular Aphasias)

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A lesion of the dominant thalamus, usually vascular and involving the posterior nuclei, may cause an aphasia, the clinical features of which are not entirely uniform Usually there is mutism initially and comprehension is impaired During the early phases of recovery, spontaneous speech is reduced in amount; less often, speech is uent and paraphasic to the point of jargon Reading and writing may or may not be affected Anomia has been described with a ventrolateral thalamic lesion (Ojemann) Characteristically, the patient s ability to repeat dictated words and phrases is unimpaired, (transcortical sensory aphasia) Complete recovery in a matter of weeks is the rule