{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T12:10:52Z","timestamp":1792671052738,"version":"4.5.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Apraxia of speech (AOS) is a motor speech disorder impairing the coordination of complex articulatory movements needed to produce speech. AOS typically co-occurs with a non-fluent aphasia, or language disorder, making it challenging to determine the specific brain structures that cause AOS. Cases of pure AOS without aphasia are rare but offer the best window into the neural correlates that support articulatory planning. The goal of the current study was to explore patterns of apraxic speech errors and their underlying neural correlates in a case of pure AOS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 67-year-old right-handed man presented with severe AOS resulting from a fronto-insular lesion caused by an ischemic stroke. The participant\u2019s speech and language were evaluated at 1-, 3- and 12-months post-onset. High resolution structural MRI, including diffusion weighted imaging, was acquired at 12\u2009months post-onset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At the first assessment, the participant made minor errors on the Comprehensive Aphasia Test, demonstrating mild deficits in writing, auditory comprehension, and repetition. By the second assessment, he no longer had aphasia. On the Motor Speech Evaluation, the severity of his AOS was initially rated as 5 (out of 7) and improved to a score of 4 by the second visit, likely due to training by his SLP at the time to slow his speech. Structural MRI data showed a fronto-insular lesion encompassing the superior precentral gyrus of the insula and portions of the inferior and middle frontal gyri and precentral gyrus. Tractography derived from diffusion MRI showed partial damage to the frontal aslant tract and arcuate fasciculus along the white matter projections to the insula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This pure case of severe AOS without aphasia affords a unique window into the behavioral and neural mechanisms of this motor speech disorder. The current findings support previous observations that AOS and aphasia are dissociable and confirm a role for the precentral gyrus of the insula and BA44, as well as underlying white matter in supporting the coordination of complex articulatory movements. Additionally, other regions including the precentral gyrus, Broca\u2019s area, and Area 55b are discussed regarding their potential role in successful speech production.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1187399","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T15:28:25Z","timestamp":1690471705000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["A case of pure apraxia of speech after left hemisphere stroke: behavioral findings and neural correlates"],"prefix":"10.3389","volume":"14","author":[{"given":"Alexis L.","family":"Pracar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria V.","family":"Ivanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Richardson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina F.","family":"Dronkers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"ref1","volume-title":"Motor speech disorders e-book: substrates, differential diagnosis, and management","author":"Duffy","year":"2019"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.bandl.2006.01.008","article-title":"Clinical and anatomical correlates of apraxia of speech","volume":"97","author":"Ogar","year":"2006","journal-title":"Brain Lang"},{"key":"ref3","volume-title":"Apraxia of speech: the disorder and its management","author":"Wertz","year":"1984"},{"key":"ref4","volume-title":"Motor speech disorders","author":"Darley","year":"1975"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1007\/s002340050764","article-title":"Apraxia of speech associated with an infarct in the precentral gyrus of the insula","volume":"41","author":"Nagao","year":"1999","journal-title":"Neuroradiology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1212\/WNL.28.4.311","article-title":"Broca aphasia: pathologic and clinical","volume":"28","author":"Mohr","year":"1978","journal-title":"Neurology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1212\/WNL.0b013e31821103e6","article-title":"Classification of primary progressive aphasia and its variants","volume":"76","author":"Gorno-Tempini","year":"2011","journal-title":"Neurology"},{"key":"ref8","first-page":"15","article-title":"Treatment guidelines for acquired apraxia of speech: a synthesis and evaluation of the evidence","volume":"14","author":"Wambaugh","year":"2006","journal-title":"J Med SpeechLang Pathol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1093\/brain\/aws032","article-title":"Characterizing a neurodegenerative syndrome: primary progressive apraxia of speech","volume":"135","author":"Josephs","year":"2012","journal-title":"Brain"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1093\/brain\/awh172","article-title":"Re-examining the brain regions crucial for orchestrating speech articulation","volume":"127","author":"Hillis","year":"2004","journal-title":"Brain"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.bandl.2012.08.007","article-title":"Re-establishing Broca\u2019s initial findings","volume":"123","author":"Richardson","year":"2012","journal-title":"Brain Lang"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1016\/j.cortex.2010.07.001","article-title":"Role of the precentral gyrus of the insula in complex articulation","volume":"47","author":"Baldo","year":"2011","journal-title":"Cortex"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1038\/384159a0","article-title":"A new brain region for coordinating speech articulation","volume":"384","author":"Dronkers","year":"1996","journal-title":"Nature"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3723","DOI":"10.1093\/cercor\/bhab043","article-title":"The precentral insular cortical network for speech articulation","volume":"31","author":"Tomaiuolo","year":"2021","journal-title":"Cereb Cortex"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1007\/s10072-019-04097-7","article-title":"Focal lesion in Dronkers\u2019 area associated with developmental apraxia of speech","volume":"41","author":"Oliveira","year":"2020","journal-title":"Neurol. Sci."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1161\/STROKEAHA.115.010402","article-title":"Damage to the left precentral gyrus is associated with apraxia of speech in acute stroke","volume":"47","author":"Itabashi","year":"2016","journal-title":"Stroke"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.bandl.2014.01.004","article-title":"The neuroanatomy of pure apraxia of speech in stroke","volume":"129","author":"Graff-Radford","year":"2014","journal-title":"Brain Lang"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1212\/WNL.0b013e31829c5ed5","article-title":"Syndromes dominated by apraxia of speech show distinct characteristics from agrammatic PPA","volume":"81","author":"Josephs","year":"2013","journal-title":"Neurology"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2783","DOI":"10.1093\/brain\/awu223","article-title":"The evolution of primary progressive apraxia of 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evaluation","author":"Curtiss","year":"1988"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1080\/02687038.2012.693584","article-title":"Verb and sentence production and comprehension in aphasia: Northwestern assessment of verbs and sentences (NAVS)","volume":"26","author":"Cho-Reyes","year":"2012","journal-title":"Aphasiology"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1016\/j.jalz.2016.10.006","article-title":"The Alzheimer\u2019s disease neuroimaging initiative 3: continued innovation for clinical trial improvement","volume":"13","author":"Weiner","year":"2017","journal-title":"Alzheimers Dement"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.neuropsychologia.2019.05.015","article-title":"Grey and white matter substrates of action 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imaging","volume":"125","author":"Andersson","year":"2016","journal-title":"Neuroimage"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3389\/fninf.2014.00008","article-title":"Dipy, a library for the analysis of diffusion MRI data","volume":"8","author":"Garyfallidis","year":"2014","journal-title":"Front Neuroinform"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"116889","DOI":"10.1016\/j.neuroimage.2020.116889","article-title":"TractoFlow: a robust, efficient and reproducible diffusion MRI pipeline leveraging Nextflow & Singularity","volume":"218","author":"Theaud","year":"2020","journal-title":"Neuroimage"},{"key":"ref47","article-title":"MI-Brain, a software to handle tractograms and perform interactive virtual dissection","author":"Rheault","year":"2016"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"672665","DOI":"10.3389\/fnhum.2021.672665","article-title":"Functional contributions of the arcuate fasciculus to language 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