Aphasia

Overview

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Snapshot

A 65-year-old woman presents to the emergency department with meaningless speech. The patient was in her usual state of health until 3 hours prior to presentation, where her daughter noticed her mother having “strange speech.” On physical examination, her speech is fluent, has paraphasic errors, and comprehension and repetition is impaired. On visual field testing there is a right upper quadrant field-cut. (Wernicke aphasia)

Introduction

Aphasia Syndromes
Aphasia	Lesion	Fluency	Comprehension	Repetition
Broca (expressive)	A lesion affectingBroca area (inferior frontal lobe) often secondary to an infarct involving thesuperior division of the left middle cerebral artery (MCA)	No	Yes	No
Wernicke (receptive)	A lesion affectingWernicke area (superior temporal lobe) often secondary to an infarct involving theinferior division of the left MCA	Yes	No	No
Conduction	A lesion affecting thearcuate fasciculus can be secondary to any lesion involving theperi-Sylvian area	Yes	Yes	No
Global	Can be secondary toa proximal MCA occlusion affecting bothsuperior and inferior division of the MCAa large superior division infarct that later becomes aBroca’s aphasialarge subcortical lesions such ashemorrhagesinfarcts	No	No	No
Transcortical motor	Can be secondary toan anterior cerebral artery (ACA)-MCA watershed infarct	No	Yes	Yes
Transcortical sensory	Can be secondary toa posterior cerebral artery (PCA)-MCA watershed infarct	Yes	No	Yes
Transcortical mixed	Can be secondary toboth an ACA-MCA and PCA-MCA infarct	No	No	Yes