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Patient Tan revisited: a case of atypical global aphasia?

Broca's first patient presented in support of a relationship between a lesion of the frontal lobe and aphasia was patient Tan. Although Pierre Marie refers to this case as "indisputably aphasia of Broca," the clinical diagnosis of Tan's aphasia has not been re-examined in light of current clinical criteria. Superficially, the patient's extremely limited verbal output and intact comprehension appear to fit with the diagnosis of Broca's aphasia, but a more thorough examination of the onset, evolution and nature of the patient's speech symptoms suggests alternate interpretations. Contemporary evidence in support of a robust relationship between stereotypical utterances and Global aphasia suggests that patient Tan may have suffered from a Global rather than Broca's aphasia.

Aphasia↗

Reconstructive retrieval deficits in Broca's aphasia.

Anterior aphasic patients' ability to utilize the phonemic and/or semantic features of verbal material for retention purposes was investigated. In the first experiment, patients were asked to either detect word repetitions, phoneme repetitions, or rhymes in a list of items. The aphasics performed well on word and phoneme repetition detection but below both normals and amnesic Korsakoffs on rhyme detection. In the second experiment the patients were instructed to analyze either the physical, phonemic, or semantic features of words they were later asked to recognize. Aphasics were differentially affected (as were normals) by these instructions: semantic feature analysis resulted in the best performance, followed by phonemic feature analysis. It was concluded that anterior aphasics can analyze, recirculate, and even store the phonemic features of words, but find difficulty in reconstructing the originally presented item from these features.

Alcohol Amnestic Disorder↗

Language after bilateral cerebral infarctions: role of the minor hemisphere in speech.

Language was studied in four patients with bilateral cerebral infarctions. Bilateral destruction of the third frontal gyri did not necessarily produce the severely limited language output characteristic of global or severe Broca aphasia; for Broca aphasia to occur, there must be extensive frontoparietal damage in the dominant cerebral hemisphere. Thus, the marked recovery of language after lesions limited to the dominant third frontal gyrus is mediated by adjacent areas of the dominant hemisphere, and not by the nondominant third frontal gyrus. The nondominant hemisphere nevertheless has a limited capacity to produce oral speech after extensive damage to the dominant hemisphere and may play an appreciable, although still subsidiary, role in normal articulation. The central gyri and rolandic operculum may be more essential than the third frontal gyri for well-articulated speech.

Adult↗

A taxonomy of misnaming aphasiacs.

A cluster analysis, based upon the naming errors of 61 non-selected aphasiacs, was performed. Three clusters emerged; the first was marked by phonemic errors, the second by semantic ones and the third by the use of escape mechanisms. Subjects in the second cluster were less impaired; this could be a consequence of the disturbance type involved. Though many patients of first and third groups displayed a Wernicke aphasia, whereas Broca aphasia predominated in the second one, a concordance of clusters with aphasiologic diagnoses was far from excellent.

Adolescent↗