Table I

Classical Aphasic Syndromes

Syndrome

Clinical manifestations

Postulated deficit

Classical lesion location

Broca's aphasia

Wernicke's aphasia

Pure motor speech disorder

Pure word deafness

Transcortical motor aphasia

Transcortical sensory aphasia

Conduction aphasia

Major disturbance in speech production with sparse, halting speech, often misarticulated, and frequently missing function words and bound morphemes

Major disturbance in auditory comprehension; fluent speech with disturbances of the sounds and structures of words (phonemic, morphological, and semantic paraphasias)

Disturbance of articulation; apraxia of speech, dysarthria, anarthria, aphemia

Disturbance of spoken word comprehension

Disturbance of spontaneous speech similar to Broca's aphasia, with relatively preserved repetition

Disturbance in single word comprehension, with relatively intact repetition

Disturbance of repetition and spontaneous speech (phonemic paraphasias)

Disturbances in the speech planning and production mechanisms

Disturbances of the permanent representations of the sound structures of words

Posterior aspects of the third frontal convolution (Broca's area)

Posterior half of the first temporal gyrus and possibly adjacent cortex (Wernicke's area)

Disturbance of articulatory mechanisms

Failure to access spoken words

Disconnection between conceptual representations of words and sentences and the motor speech production system

Disturbance in activation of word meanings despite normal recognition of auditorily presented words

Disconnection between the sound patterns of words and the speech production mechanism

Outflow tracts from motor cortex

Input tracts from auditory system to Wernicke's area

White matter tracts deep to

Broca's area connecting it to parietal lobe

White matter tracts connecting parietal lobe to temporal lobe or portions of inferior parietal lobe

Lesion in the arcuate fasciculus and/or corticocortical connections between Wernicke's and Broca's

Anomic aphasia

Global aphasia

Isolation of the language zone

Disturbance in the production of single words, most marked for common nouns with variable comprehension problems Major disturbance in all language functions

Disturbance of both spontaneous speech (similar to Broca's aphasia) and comprehension, with some preservation of repetition

Disturbances of concepts and/or the sound patterns of words

Disruption of all language processing components

Disconnection between concepts and both representations of word sounds and the speech production mechanism

Inferior parietal lobe or connections between parietal lobe and temporal lobe; can follow many lesions

Large portion of the peri-Sylvian association cortex

Cortex just outside the peri-Sylvian association cortex areas approaches to the description of aphasia. For instance, Hughlings Jackson described a patient, a carpenter, who was mute but who mustered the capacity to say "master's'' in response to his son's question about where his tools were. Jackson's poignant comments convey his emphasis on the conditions that provoke speech rather than on the form of the speech:

The father had left work; would never return to it; was away from home; his son was on a visit, and the question was directly put to the patient. Anyone who saw the abject poverty the poor man's family lived in would admit that these tools were of immense value to them. Hence we have to consider as regards this and other occasional utterances the strength of the accompanying emotional state.

Jackson and others sought a description of language use as a function of motivational and intellectual states and tried to describe aphasic disturbances of language in relationship to the factors that drive language production and make for depth of comprehension. This is a vital aspect of understanding language impairments. In many ways, it is more humanly relevant than a description of language impairments in terms of which phonemes are produced in spontaneous speech or repetition. Unfortunately, it is a very intractable goal, both in terms of psychological descriptions and in terms of relating these specific motivational states to the brain. The researchers who conceived and developed the framework of the classical syndromes focused aphasiology on the description of the linguistic representations and psycho-linguistic operations that are responsible for everyday language use.

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