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Where is language located in the brain? Is the human brain specialized for language? Are there sensitive periods for acquisition? Is any aspect of language innate? Are there learning mechanisms dedicated to language? Wernicke and Broca identified language areas for comprehension and production in the left hemisphere, and modern studies rely on PET, fMRI, and MEG for tracking just where information is processed. It is unclear whether there is a sensitive period for language acquisition. Evidence from brain injuries and feral children is problematic. Evidence from second language learning is rarely comparable in amount of experience, feedback, and practice to first language. As children acquire more language, they process it faster, with greater left-hemisphere specialization. With bilingualism comes greater density in the left hemisphere. Sign languages are also processed in the left hemisphere. But some aspects of language are processed in the right hemisphere. Language is part of a more general system of communication, with affect, facial expression, gesture, and stance, so storage in the brain occurs in both hemispheres.
We report a case of a 56-year old woman with a history of depressive disorder between 2012 and 2017 achieving full remission after treatment with antidepressants and anxiolytics. In the year 2021 was presented to the emergency department manifesting alteration of behavioral patterns, ataxia, mental confusion and horizontal nystagmus. A chronic alcohol abuse was also discovered while interviewing. She also exhibited low mood, anterograde amnesia and confabulations that improved rapidly after following treatment with thiamine.
Objectives
Reviewing clinical manifestations and treatment of Wernicke encephalopathy and the development of Korsakoff syndrome.
Methods
We systematically reviewed articles using PubMed.
Results
Wernicke encephalopathy is a well-known complication of thiamine deficiency, mostly associated with alcohol use disorder. Classically, the syndrome comprises changes in mental status, gait ataxia and ophthalmoplegia. However, the full triad has been described in only 10-17 % of cases, which in our the case is report. After the diagnosis was established and was treated with thiamine, a rapid improvement in the patient´s clinical status was observed. Cognitive impairment was later identified, taking into account the possibility of a Korsakoff syndrome characterized by irreversible brain damage and subsequent loss of anterograde memory. In our patient, this specific diagnosis was dismissed due to the clinical improvement after thiamine treatment.
Conclusions
It is relevant to emphasize the importance of a precise diagnosis and treatment of patients with Wernicke Encephalopathy to avoid the development of a Korsakoff syndrome.
To develop and test a novel fMRI compatible comprehensive and expressive language task that reliably and predictably activates both Wernicke's and Broca's cortical brain regions, respectively, and has utility for the determination of hemispheric language dominance.
Methods:
Ten healthy men (seven) and women (three) were administered a task based on the television game Jeopardy that was adapted for fMRI presentation. The task was programmed using E-PRIME software and designed to run as an event-related experiment. The study was conducted on 3 T MRI Phillips Intera scanner, and data was anlysed using Brain Voyager QX. All subjects provided written informed consent.
Results:
The Jeopardy task produced robust left hemisphere activation in regions corresponding to Wernicke's and Broca's areas.
Conclusion:
This novel fMRI compatible task (Jeopardy) reliably maps both Broca's and Wernicke's areas with robust hemispheric lateralization. It is potentially useful in language localization studies as it offers advantages over conventional procedures and other fMRI tasks by virtue of being non-invasive and mapping both language areas in one experiment.
Alcoholic polyneuritis with characteristic mental symptoms was described by Sergei Korsakov in 1887; Wernicke confirmed and extended his observations, and modern high-resolution magnetic resonance imaging techniques make it possible to relate the confabulatory amnesia with abnormally small mammillary nuclei.
Carl Wernicke [1848-1905] gave the first description of sensory aphasia [1874] and of ophthalmoplegic encephalopathy [1881]. In addition, his notion of ‘Sejunction’ [1894] foreshadowed Bleuler's ‘schizophrenia [1908], and he may be justly said to have been the first successful organic neuropsychiatrist.
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