Clinical Neurology · Neurological Examination

Aphasias

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Classification of the aphasias by core language features — fluency, repetition, and comprehension — together with the typical lesion localization. The pattern of preserved versus impaired repetition is especially useful in distinguishing the perisylvian aphasias from the transcortical (border-zone) syndromes.

Syndrome	Fluency	Repetition	Comprehension	Localization
Broca’s	Poor	Poor	Good	Dominant premotor cortex, area 44.
Wernicke’s	Good	Poor	Very poor	Posterior portion of dominant superior temporal gyrus.
Conduction	Good	Poor	Good	Supramarginal gyrus & arcuate fasciculus, or insula & auditory cortex.
Global	Poor	Poor	Poor	Extensive damage to language areas in dominant cortex.
Transcortical motor	Poor	Good	Good	Anterior border zone between major arteries.
Transcortical sensory	Good	Good	Poor	Posterior border zone between major arteries.
Isolation of speech area	Poor	Good	Poor	Extensive border zone between major arteries.
Anomic aphasia	Good but with word finding pauses	Good	Good	Non-specific sign, common with 2nd and 3rd temporal gyrus.
Alexia without agraphia	Good	Good	Good	Posterior corpus callosum and left occipital lobe.
Alexia with agraphia	Good	Good	Good	Left inferior parietal (angular gyrus).
Pure word deafness	Good	Poor	Absent	Bilateral temporal lesions.

Ahmed Koriesh, MD