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
Wernicke’sImpairedImpairedImpairedPreserved or increased
Broca’sPreserved (except grammar)ImpairedImpairedDecreased
Nonfluent (anterior) transcorticalPreservedPreservedImpairedImpaired
Fluent (posterior) transcorticalImpairedPreservedImpairedPreserved
IsolationImpairedEcholaliaImpairedNo purposeful speech
AnomicPreservedPreservedImpairedPreserved except for word-finding pauses
Pure word deafnessImpaired only for spoken languageImpairedPreservedPreserved
Pure alexiaImpaired only for readingPreservedPreservedPreserved

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