Today in Morning Report we talked about a woman with acute onset of word-finding difficulties and recognition. Here is simple approach to aphasia:
*Remember: APHASIA = impairment in language. DYSARTHRIA = motor speech problem.
Broca's area and Wernicke's area are the main language areas located in the perisylvian language area, they are joined by the arcuate fasciculus.
*All aphasias have naming problems.
1) Can the patient repeat? (Assess repetition)
- Repeat after me: "no ifs, ands, or buts"
- if yes: perisylvian language area intact, therefore lesion in area around perisylvian language area = transcortical aphasia
- 2) Is the patient able to comprehend? (Assess comprehension, simple commands)
- easy questions: close your eyes, to more difficult: point to your nose with your right hand
- If yes: "Transcortical motor aphasia"
- If no: "Transcortical sensory aphasia"
- if no repetition: lesion within perisylvian language area
- 2) Is the patient able to comprehend?
- If yes: "Broca's aphasia"
- If no: "Wernicke's aphasia"
Summary:
Broca's Aphasia
- can understand, cannot repeat ("patient is frustrated")
- not fluent
Wernicke's Aphasia
- cannot comprehend, cannot repeat
- fluent (but non-sensical speech, not coherent) - word salad ("examiner is frustrated")
Transcortical Motor Aphasia
- like Broca's aphasia but CAN repeat
- usually lesion near Broca's area but not in the perisylvian area (in the frontal cortex)
Transcortical Sensory Aphasia
- like Wernicke's aphasia but CAN repeat
Global Aphasia
- cannot comprehend, cannot repeat, not fluent, cannot read, cannot write (usually mute)
- suggests large lesion affecting both Broca's and Wernicke's areas (ex. Large MCA stroke)
Anomic Aphasia
- difficulty naming but no other deficits
- does not localize
Conduction Aphasia
- cannot repeat, but everything else intact
- lesion in the Arcuate Fasciculus (the fibers that connect Broca's and Wernicke's); the two main areas are intact but the listening and the speaking parts of the brain can't connect
