speech Flashcards
A 65-year-old man is brought to the emergency department by his wife with an onset of confusion, since waking up in the morning. She tells you that her husband is not making any sense when he talks. There is no history of cognitive impairment or recent head injury. His past medical history includes type 2 diabetes, chronic pancreatitis and recurrent urinary tract infections.
On examination, his observations are normal. His motor and sensory examination are unremarkable. He is able to talk in full sentences but his answers are incomprehensible.
This patient has Wernicke’s aphasia given the history of fluent, yet confused speech. Wernicke’s aphasia occurs following a lesion to the superior temporal gyrus and a common cause includes cerebral infarction (e.g. infarction of the middle cerebral artery). The acute onset of symptoms and past medical history of type 2 diabetes make the likelihood of this patient having a stroke increase. Wernicke’s area provides meaning to speech. Therefore, a patient with Wernicke’s aphasia will talk fluently (as does this patient, talking in sentences). However, the content will not make sense.
Broca’s aphasia causes non-fluent speech. Patients often have word-finding difficulties. However, comprehension remains intact. Broca’s area is within the frontal lobe and is often affected by infarction of the anterior cerebral artery. The patient in the above scenario speaks fluently but incoherently, making Broca’s aphasia unlikely.
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