LANGUAGE

II
Anatomy of
Language Areas
•(A) Core language circuit
composed of Broca’s area,
Wernicke’s area, and the
arcuate fasciculus. (B) Network
of areas involved in language,
including interactions with
adjacent anterior and posterior
association cortex, subcortical
structures, and callosal
connections to the contralateral
hemisphere
•Broca’s area connects with
other regions of the frontal
lobes, including the prefrontal
cortex, premotor cortex, and
supplementary motor area.
These areas function together
with Broca’s area, primarily in
higher-order motor aspects of
speech formulation and
planning.
When one is reading, visual information first reaches primary
visual cortex in the occipital lobes, is processed in visual
association cortex, and then travels anteriorly via the angular
gyrus to reach the language areas.

Connections through the corpus callosum allow the nondominant

hemisphere to participate in the language-processing network.

The nondominant hemisphere appears to be important in both

the recognition and the production of the affective elements of
speech.
 Disorders of speech production
•Dysarthria
•Aphemia (verbal apraxia)

Disorders
•Mutism
Auditory disorders
•Peripheral hearing loss

Commonly •Pure word deafness

•Cortical deafness

Mistaken
Defects in arousal and attention
•Global confusional state
•Narcolepsy

for Aphasia Psychiatric disorders

•Schizophrenia
•Conversion disorder and other
•somatoform disorders
Uncooperative patient
 DIFFERENTIAL DIAGNOSIS OF
LANGUAGE DISORDERS
• Aphasia, or dysphasia, is a defect in language processing caused by dysfunction of the
dominant cerebral hemisphere.

• Because aphasia is a disorder of language and not a simple sensory or motor deficit,
both spoken language and written language are affected.

• Aphasia is not caused by impaired audition or articulation, although deficits in these

modalities may coexist with aphasia. The
 Causes of Aphasia

Cerebral contusion; subdural or epidural hematoma Ischemic or hemorrhagic vascular events

 Ictal or post-ictal deficit with focal
seizures in dominant hemisphere

Michael Owen Kinney, Stjepana Kovac, Beate Diehl, Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long
term monitoring, Seizure, Volume 72, 2019, Pages 13-22, ISSN 1059-1311, https://doi.org/10.1016/j.seizure.2019.08.008.
Mass lesions such as brain tumor, abscess, Inflammatory or autoimmune
or toxoplasmosis disorders such as multiple
sclerosis or vasculitis
Degenerative disorders such as progressive nonfluent Developmental disorders such
aphasia, semantic dementia, moderately advanced as language delay or autism
Alzheimer’s disease, and Huntington’s disease
 BEDSIDE LANGUAGE EXAM

1. Spontaneous speech 4. Repetition

Fluency Single words
Prosody Simple sentences
Grammar and meaning Complex sentences
Paraphasias 5. Reading
Articulation Aloud
2. Naming Comprehension
Visual confrontation naming 6. Writing
Responsive naming Patient’s name
Objects and parts Copy sentence
Nouns, verbs, proper nouns, colors, etc. Spontaneous sentence
3. Comprehension
Commands, simple to complex
Yes/no questions and multiple choice
Point to objects
Syntax-dependent meaning
 OTHER SYNDROMES RELATED TO APHASIA

Alexia and Agraphia

Alexia and agraphia are impairments in reading or writing ability, respectively, that are
caused by deficits in central language processing and not by simple sensory or motor
deficits.

Gerstmann’s Syndrome
Gerstmann’s syndrome consists of the following somewhat odd tetrad of clinical findings:
(1) agraphia, (2) acalculia (impaired arithmetic calculating abilities), (3) right–left
disorientation (difficulty identifying the right versus left side of the body), and (4) finger
agnosia (inability to name or identify individual fingers). Agnosia has been defined by
Teuber as “a normal percept stripped of its meanings.
Apraxia
Apraxia, or, more specifically, ideomotor apraxia, is the inability to carry
out an action in response to verbal command, in the absence of any
comprehension deficit, motor weakness, or incoordination. It is caused
by an inability to formulate the correct movement sequence.

Aphemia (Verbal Apraxia)

In aphemia, patients have severe apraxia of the speech articulatory
apparatus, without a language disturbance. Aphemia is usually caused
by a small lesion of the dominant frontal operculum restricted to Broca’s
area. In contrast to patients with Broca’s aphasia, these patients have
normal written language. Patients with aphemia have effortful, poorly
articulated speech sometimes referred to as foreign accent syndrome.
Cortical Deafness, Pure Word Deafness, and Nonverbal Auditory Agnosia
Patients with cortical deafness have bilateral lesions of the primary auditory cortex
in Heschl’s gyrus. These patients are often aware that a sound has occurred but are
unable to interpret verbal stimuli and cannot identify nonverbal stimuli such as a
telephone ringing or a dog barking. In contrast, patients with pure word deafness, or
verbal auditory agnosia, can identify nonverbal sounds but cannot understand any
spoken words. Unlike Wernicke’s aphasia patients, these patients can read and
write normally. Although a few paraphasic errors may occur early on, speech is
usually normal within a few days of onset.