Broca's aphemia: an illustrated account of its clinico-anatomic validity

Abstract

-Objective: To present the case of a 54-year-old man with loss of speech, but with preservation of voluntary facio-lingual motility, language and other cognitive abilities (Broca's aphemia). Method: Observation of patient oral communicative abilities and general behavior, neuropsychological assessment and cranial computed tomography. Results: Computed tomography showed a hyperdense lesion in the subcortex of the left precentral gyrus corresponding to Brodmann's area 6 and 44. Neuropsychological assessment confirmed that the major cognitive domains were intact. Conclusion: Our patient reiterates the validity of Broca's aphemia as a clinico-anatomic entity allowing us to portray it for the first time in pictures. From a neurobehavioral perspective, aphemia is related to apraxia rather than to aphasia, a fact that may have hampered the full grasp of its far-reaching implications for neurology and aphasiology.KEY WORDS: aphemia, Broca's area, Broca's aphasia, apraxia. Afemia de Broca: um relato ilustrado sobre sua validade anátomo-clínicaRESUMO -Objetivo: Apresentar o caso de um paciente de 54 anos de idade com perda da fala, mas preservação da linguagem, das demais capacidades cognitivas, e da motilidade fácio-lingual voluntária (afemia de Broca). Método: Observação da capacidade de comunicação oral e do comportamento geral, exame neuropsicológico e tomografia computadorizada do crânio. Resultados: A tomografia computadorizada revelou lesão hiperdensa no subcórtex do giro precentral esquerdo correspondendo às áreas 6 e 44 de Brodmann. O exame neuropsicológico confirmou que os principais domínios cognitivos se encontravam intactos. Conclusão: Nosso paciente reiterou a validade da afemia de Broca como entidade anátomo-clínico permitindo documentá-la em fotos pela primeira vez. Da perspectiva neurocomportamental, a afemia está vinculada às apraxias e não às afasias, o que pode ter prejudicado a apreensão plena do seu profundo significado para a neurologia e para a afasiologia. PALAVRAS-CHAVE: afemia, área de Broca, afasia de Broca, apraxia.

Poor Spontaneous Recovery of Aphemia Accompanied by Damage to the Anterior Segment of the Left Arcuate Fasciculus: A Case Report

“…It was speculated that this condition could be mainly caused by lesions affecting the cortical areas such as the lower part of the left primary motor cortex and the contiguous premotor cortex [ 5 ] or the posterior third of the left inferior frontal gyrus [ 6 , 7 ]. Especially, it was reported that the lesion responsible for aphemia was usually located in the opercular portion of the inferior frontal gyrus [ 3 , 5 ]. The frontal operculum consists of the kinetic formula which supports the automatic conversion of verbal language into speech.…”

“…The aphasia quotient (AQ) was 31.0. According to the report of Broca and the description of Oliveira-Souza Rd et al [ 3 ], he was diagnosed with aphemia. A follow-up brain MRI, carried out two months after the onset of the stroke, demonstrated an old ischemic lesion in the left hemisphere ( Figure 1 B).…”

“…This condition was first reported by Broca in 1861 but is rarely encountered in clinical practice. Broca initially used the term “Aphemia” to describe a singular symptom of language deficits in a patient who presented with the loss of speech but without the impairment of language [ 3 ]. They retained the ability to move the faciolingual territories employed in speech.…”

“…Several previous reports [ 5 , 6 , 7 ] have speculated that damage to the cortical areas may be an important underlying factor for aphemia. As well, it was also postulated that injury to the subcortical fiber tracts could also cause aphemia [ 3 , 5 ]. However, this topic has not been reported on, and little is known about the role of white matter pathways in aphemia.…”