Clinical picture of decompensated aphasias due to posterior localization of the lesion of the left brain hemisphere
At present, it seems relevant to differentiate the clinical criteria for the rough severity of aphasia caused by focal lesions of the posterior cerebral cortex, since the role of non-speech higher mental functions in the structure of these syndromes has not been studied. The purpose - determination of clinical criteria for the rough severity of aphasia due to posterior localization of the lesion of the left brain hemisphere. Material and methods. The work was carried out in the neurological clinic Moscow Regional Clinical Research Institute named after M.F. Vladimirskiy. The study involved 123 patients with severe aphasia, provoked by local disturbance of cerebral circulation in the posterior parts of the left (dominant) hemisphere. All patients participating in the study underwent magnetic resonance imaging of the brain in order to confirm the posterior localization of the lesion caused by a stroke. Then, standardized neurological, speech therapy scales were applied, which made it possible to confirm a gross severity in all 123 patients, and an extended psychological diagnosis aimed at analyzing the cognitive sphere in the studied group of patients. We assessed the tightness of the relationship between the rough severity of aphasia syndromes due to the posterior localization of the lesion of the dominant cerebral hemisphere with impaired non-speech higher mental functions, by calculating the associative coefficient by the formula KAC = ad - bc / ad + bc. Thus, the structural components of the rough severity of the syndromes of acoustic-gnostic, acoustic-mnestic and semantic aphasia were identified, which contributed to the clinical assessment of the factors affecting the symptoms of decompensated aphasia caused by the posterior localization of the lesion focus of the dominant brain hemisphere. Results. Expanded psychological diagnostics aimed at analyzing the cognitive sphere showed that the entire observed group of patients (123 people) had changes in non-verbal higher mental functions of a specific type: 1) neurodynamic disturbances in the syndrome of acoustic-gnostic aphasia; 2) systemic mnestic and visual gnostic disorders in acoustic-mnestic aphasia syndrome; 3) systemic disorders, interconnected with the difficulty in processing polymodal information obtained from various analyzer organs, which, first of all, was reflected in the visual-spatial perception defect in semantic aphasia syndrome. It was determined that for all three clinical forms of aphasia, KAC =1. Conclusion. Controlled psychological study of the posterior forms of aphasia contributed to the establishment of a single mechanism for the rough severity of the syndromes studied. The conclusion was made that there is a direct dependence and strong feedback of a gross severity and impaired non-speech higher mental functions.