Chapter 027. Aphasia, Memory Loss, and Other Focal Cerebral Disorders (Part 3)

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The correspondence between individual deficits of language function and lesion location does not display a rigid one-to-one relationship and should be conceptualized within the context of the distributed network model. Nonetheless, the classification of aphasias of acute onset into specific clinical syndromes helps to determine the most likely anatomic distribution of the underlying neurologic disease and has implications for etiology and prognosis (Table 27-1). The syndromes listed in Table 27-1 are most applicable to aphasias caused by cerebrovascular accidents (CVA). They can be divided into "central" syndromes, which result from damage to the two epicenters of the language network...

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Nội dung Text: Chapter 027. Aphasia, Memory Loss, and Other Focal Cerebral Disorders (Part 3)

Chapter 027. Aphasia, Memory Loss, and Other Focal Cerebral Disorders (Part 3) The correspondence between individual deficits of language function and lesion location does not display a rigid one-to-one relationship and should be conceptualized within the context of the distributed network model. Nonetheless, the classification of aphasias of acute onset into specific clinical syndromes helps to determine the most likely anatomic distribution of the underlying neurologic disease and has implications for etiology and prognosis (Table 27-1). The syndromes listed in Table 27-1 are most applicable to aphasias caused by cerebrovascular accidents (CVA). They can be divided into "central" syndromes, which result from damage to the two epicenters of the language network (Broca's and Wernicke's areas), and "disconnection" syndromes, which arise from lesions that interrupt the functional connectivity of these centers with each other and with the other components of the language network. The syndromes outlined below are idealizations; pure syndromes occur rarely.
Table 27-1 Clinical Features of Aphasias and Related Conditions Comprehe Repeti Nami Fluen nsion tion of ng cy Spoken Language Wernicke's Impair Impai Impai Preser ed red red ved or increased Broca's Preserv Impai Impai Decre ed (except red red ased grammar) Global Impair Impai Impai Decre ed red red ased Conduction Preserv Impai Impai Preser ed red red ved
Nonfluent Preserv Preser Impai Impair (motor) ed ved red ed transcortical Fluent Impair Preser Impai Preser (sensory) ed ved red ved transcortical Isolation Impair Echol Impai No ed alia red purposeful speech Anomic Preserv Preser Impai Preser ed ved red ved except for word- finding pauses Pure word Impair Impai Preser Preser deafness ed only for red ved ved spoken
language Pure alexia Impair Preser Preser Preser ed only for ved ved ved reading Wernicke's Aphasia Comprehension is impaired for spoken and written language. Language output is fluent but is highly paraphasic and circumlocutious. The tendency for paraphasic errors may be so pronounced that it leads to strings of neologisms, which form the basis of what is known as "jargon aphasia." Speech contains large numbers of function words (e.g., prepositions, conjunctions) but few substantive nouns or verbs that refer to specific actions. The output is therefore voluminous but uninformative. For example, a patient attempts to describe how his wife accidentally threw away something important, perhaps his dentures: "We don't need it anymore, she says. And with it when that was downstairs was my teeth-tick . . . a . . . den . . . dentith . . . my dentist. And they happened to be in that bag . . . see? How could this have happened? How could a thing like this happen. . .So she says we won't need it anymore. . .I didn't think we'd use it. And now if I have any problems anybody coming a month from now, 4 months from now, or 6 months from now, I have a new dentist. Where my two . . . two little pieces of dentist that
I use . . . that I . . . all gone. If she throws the whole thing away . . . visit some friends of hers and she can't throw them away."