Chapter 57: Aphasia

Aphasias are disturbances in the comprehension or production of spoken or written language. Clinical examination should assess spontaneous speech (fluency), comprehension, repetition, naming, reading, and writing. A classification scheme is presented in Table 57-1. In nearly all right-handed individuals and many left-handed pts, language localization is in the left hemisphere.

TABLE 57-1: Clinical Features of Aphasias and Related Conditions Commonly Seen in Cerebrovascular Accidents
	COMPREHENSION	REPETITION OF SPOKEN LANGUAGE	NAMING	FLUENCY
Wernicke’s	Impaired	Impaired	Impaired	Preserved or increased
Broca’s	Preserved (except grammar)	Impaired	Impaired	Decreased
Global	Impaired	Impaired	Impaired	Decreased
Conduction	Preserved	Impaired	Impaired	Preserved
Nonfluent (anterior) transcortical	Preserved	Preserved	Impaired	Impaired
Fluent (posterior) transcortical	Impaired	Preserved	Impaired	Preserved
Isolation	Impaired	Echolalia	Impaired	No purposeful speech
Anomic	Preserved	Preserved	Impaired	Preserved except for word-finding pauses
Pure word deafness	Impaired only for spoken language	Impaired	Preserved	Preserved
Pure alexia	Impaired only for reading	Preserved	Preserved	Preserved

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