Hello again all,

Can anyone point me to any sources discussing differences in the areas of the brain that control written word versus verbalized speech? Also, if anyone is aware of any sources regarding aphasia selectively affecting verbal function versus writing? Finally, I am also curious about the possibility of aphasia progressively worsening after an injury.

Quick update: Finally visited neurologist. I was worried at first but the examination seemed to go fine. He said he is concerned this is more than PCS and asked for 2 more weeks to review brain & neck CTs and MRIs then return to f/u and order more testing.

Also referred for neuropsych evaluation and ordered not to return to work.

With my wife's help and the use of the TBI Survival Guide we compiled a good list of symptoms and and history/progression of them. He also found hyperactivity in reflexes of my feet he said could indicate either more severe brain injury or a spinal cord injury to go along with it.

The aphasia seems to be progressively getting worse, though. I'm not sure when but I have developed a stutter in my speech.

What I did notice is that given a pen and blank white paper I can write out my thoughts whereas I complet freeze up when attempting to verbalize them.

I would also note that despite having normal blood pressure for years, I have been in th ER twice last week with hypertensive crisis (165/114 and 182/111). This could be a response to pain or stress/anxiety as I struggle with new reality.

And the fact some symptoms seem to be worsening could be related to starting a journal last week which means I now have a better MEMORY of my symptoms.

In any case, I am baffled/scared/intrigued both by the vast differences in my writing and verbal skills and what seems to be a progression of symptoms . I didn't seem to find anything else on point here so hoped someone else might
know. That and I just like to read Mark and Lara and MrsD, etc, comments!

Forgive if but I'm in a dither today. Major computer problem and I'm just starting up again on a new operating system and my mind is a bit disoriented but hopefully I can post something useful for now

I'm really sorry you've had such a downturn. Is this downturn only since you went to the ER and were given that drug last week or had you noticed it coming on before that crisis?

Expressive aphasia is associated with migraine just so you know. You were in the ER with migraine weren't you?

I used to know a little about speech and language disorders from when my son was little. He is on autism spectrum. That was a long time ago now though.

I would recommend looking at Speech and Language sites really. They would have information about aphasia. There are quite a number of different presentations of aphasia. Some are quite severe and some are not. It can vary depending on the area of the brain affected.

Anyway, I'll post a few things and hopefully others here from the forum can give you some suggestions about this as well. I'm sure you're not the only one to have some temporary aphasia after a head injury here.

http://www.asha.org/Practice-Portal/...ns-of-Aphasia/
Appendix : Common Classifications of Aphasia
American Speech-Language-Hearing Association

http://www.nidcd.nih.gov/health/voic...sia.aspx#types
from National Institute of Deafness and Other Communication Disorders

The wiki page actually has a good overview of Aphasia with links to different types.
http://en.wikipedia.org/wiki/Aphasia

I found references for Goodglass and Kaplan (1983) The Assessment of Aphasia and Related Disorders. 2nd ed. Philadelphia: Lea & Febiger that suggests that people with Anomic Aphasia can have aphasia but have good writing skills. I'll try to find that old article as it apparently shows information about different areas of the brain that are involved. Edited to add: it's a book not an article.

What's happening with the foot reflex? Did your doctor say Babinski reflex/sign?

Wow, Lots of information to digest.

Because of the different ways these symptoms can manifest, I use layman's terms.

First, many have seen their word finding problems worsen then improve over time. Mine was much worse than it is now. Plus, many find it gets worse when under stress or any kind of time crunch as in when needing to respond to a question, especially if the answer takes cognitive effort.

I find a big difference between verbal word finding and written word finding. I chalk it up to the fact that when I am writing, I can see what I am saying and that triggers my mind differently. That ability to visually contextualize is a big help. That does not help when speaking. When I get stuck verbally, I can often trigger my thoughts by looking around the room, sort of saying the names of the things I see. It is amazing how this can trigger my mind into new areas to find the word.

I also sometimes experience a struggle getting the word from my thoughts to my mouth. I know the word or words I want to say but can not get my mouth to form the word. It is like my mouth has lost the connection to the muscle memory to say the words. I don't have that problem anymore except on rare occasions. It probably helps that I have learned to rehearse the things I am going to say before trying to say them. That has helped me sound much more thoughtful.

As you look into these issues, you may find other tricks and work-arounds. I find that sometimes I just needs to explain that my brain injury causes me to struggle with word finding problems. And, the complexity of the word is not always a complicating factor. Simple words can be just as problematic.

Regarding the BP episodes, I have emergency BP meds, propranolol. I have had BP spikes to 255/185, stroke levels. Your experiences are bad but not nearly as dangerous. My wife experiences similar BP spikes to yours. Her PCP has prescribed her a similar emergency med supply.

Regarding the foot test, I have had a positive Babinski since I was a teenager. It is just an indicator but not valid at determining outcome/recovery or injury intensity.

Regarding the sense that symptoms are getting worse. They could be or there could be another explanation. The brain can easily ignore things it can not define. They become abnormal blips. Once you have keyed in on them with the information from the Survival Guide or other sources, the brain has now indexed those issues. It will now collect episodes of this symptom. It is the same reason you start to notice all of the same model cars as one you just bought.

Rehabilitation specialists have found that there is a value to learning to accept symptoms and learn work-arounds and accommodations. Subjects who do this have better outcomes. This acceptance reduces anxiety which is helpful with recovery.

I can understand you struggles as an attorney who is dependent on your verbal skills, both written and spoken. Hopefully, your job can focus your efforts on written work. Communicating by email with co-workers could be a big help. You would qualify as disabled by ADA standards. Some accommodations would be justifiable.

The Neuro Psych Assessment will be very helpful.

My best to you.

I don't know if this is helpful or not but I have similar issues. My writing remains fluent and easy while my speech not so much. I have trouble with defining and explaining, while talking about nothing (shooting the s***t I think you call it!) is fine. When under sensory demands I

stutter, my speech slows, and I can lose the thread mid thought. I find that any extra demand on the brain effects my speech. I would suggest you not worry about it getting worse (i know easier said than done). I've been at this a long time and worrying about something that may or may not happen is exhausting and takes from any quality of life you have right NOW. Just the freaking out over your speech worsening can cause your speech to worsen.

It sounds like you have a great neurologist which can be very hard to find
Besides self care, both physically and emotionally, we really have very little control.