A Clinical Study of 100 Aphasic Patients

Abstract

The disciplines of neurology and speech pathology were combined in a clinical study of 100 aphasic pa-tients. In this study, language was considered to consist of 4 interrelated components: listening, speaking, reading and writing. "Aphasia" is an acquired primary defect in one or more of these 4 major components. Each component was tested individually and the results were related to other neurologic deficits and to the lateralization and localization of lesions. The 4 chief groups of aphasic defects are (1) severe involvement of all language components, or global defect, (2) predominant defect of reading, (3) predominant defect of speaking or writing or both and (4) mixed minor defects. Exclusive of patients with unknown or bilateral lesions, 94% of the group had lesions in the left hemisphere; 9% of these were left-handed or ambidextrous. Of 6 patients with right-hemisphere lesions, 3 were right-handed, 2 were ambidextrous and one was left-handed. Among right-handed aphasics, the lesion was located in the left hemisphere in 96% of instances; among left-handed and ambidextrous patients, the lesion was in the left hemisphere in 73% of instances. The aphasia was due to infarcts in 68 patients, mass lesions in 25 and other causes in the remaining seven. Aphasia manifested mainly by reading defect was most often due to infarct, most often as-sociated with homonymous hemianopsia and most often caused by small lesions. In 84% of these cases, the lesion involved the posterior temporal or anterior occipital region. Global aphasia most often was associated with severe neurologic signs (hemiparalysls, hemianesthesia and hemlanopsia). The midtemporal-anterior parietal region was involved in 87% of cases, but the lesions often were large, involving adjacent areas. Patients with predominant defects of speaking or writing or both often had milder neurologic signs, hypesthesia for discriminative sensation, and an equal incidence of small and large lesions. The lesion implicated the mldtemporal-anterior parietal region in 95% of cases. Mixed minor defects were associated with neurologic signs similar to but milder than those in global defects. The incidence of large and small lesions was about equal. The midtemporal-anterior parietal region was involved in 96% of cases. Certain trends in lateralization and localization were noted, but absolute relationships were not found.