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
AphasiaLesionFluencyComprehensionRepetition
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 YesNo
Wernicke (receptive) A lesion affectingWernicke area (superior temporal lobe)  often secondary to an infarct involving theinferior division of the left MCAYesNoNo
Conduction A lesion affecting thearcuate fasciculus can be secondary to any lesion involving theperi-Sylvian areaYesYesNo
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 ashemorrhagesinfarctsNoNoNo
Transcortical motorCan be secondary toan anterior cerebral artery (ACA)-MCA watershed infarct NoYesYes
Transcortical sensoryCan be secondary toa posterior cerebral artery (PCA)-MCA watershed infarctYesNoYes
Transcortical mixedCan be secondary toboth an ACA-MCA and PCA-MCA infarctNoNoYes