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substitutions, especially for consonants The most notable feature of this type of speech disorder is its transience; within a few weeks or months, language is restored to normal Bastian and more recently other authors have called this syndrome aphemia, a term that was used originally by Broca in another context to describe the severe motor aphasia that now carries his name Probably the syndrome is closely allied to the mini-Broca s aphasia described on page 417 The anatomic basis of pure word mutism has not been determined precisely In a few postmortem cases, reference is made to a lesion in Broca s area Damasio and Geschwind have stated that the lesion is anterior and superior to this area A well-studied case has been reported by Roch-LeCours and Lhermitte Their patient uttered only a few sounds for 4 weeks, after which he recovered rapidly and completely From the onset of the stroke, the patient showed no disturbance of comprehension of language or of writing Autopsy disclosed an infarct that was con ned to the cortex and subjacent white matter of the lowermost part of the precentral gyrus; Broca s area, one gyrus forward, was completely spared Other cases have involved mainly Broca s area Anomic (Amnesic, Nominal) Aphasia Some degree of word nding dif culty is probably part of every type of language disorder, including that which occurs with the confusional states and dementia In fact, without an element of anomia, a diagnosis of aphasia is usually incorrect Only when this feature is the most notable aspect of language dif culty is the term anomic aphasia employed In this latter condition, a relatively uncommon form of aphasia, the patient loses only the ability to name people and objects There are typical pauses in speech, groping for words, circumlocution, and substitution of another word or phrase that is intended to convey the meaning Perseveration may be prominent Or the patient may simply fail to name a shown object, in contrast to the usual aphasic patient, who produces a paraphasic error Less frequently used words give more trouble When shown a series of common objects, the patient may tell of their use, or demonstrate the same, instead of giving their names The dif culty applies not only to objects seen but to the names of things heard or felt (Geschwind), but this is more dif cult to demonstrate In addition to displaying normal uency of spontaneous speech and preserved comprehension and repetition, the patients we have seen with anomic aphasia have been surprisingly adept in spelling Beauvois and coworkers have described a form of bilateral tactile aphasia due to a left parieto-occipital lesion in which objects seen and verbally mentioned could be named, but not those felt with either hand Recall of the names of letters, digits, and other printed verbal material is almost invariably preserved, and immediate repetition of a spoken name is intact That the de cit is principally one of naming is shown by the patient s correct use of the object and, usually, by an ability to point to the correct object on hearing or seeing the name and to choose the correct name from a list The patient s understanding of what is heard or read is normal There is a tendency for patients to attribute their failure to forgetfulness or to give some other lame excuse for the disability, suggesting that they are not completely aware of the nature of their dif culty Of course, there are patients who fail not only to name objects but also to recognize the correct word when it is given to them In such patients, the understanding of what is heard or read is not normal, ie, the naming dif culty is but one symptom of another type of aphasic disorder. qr code reader library .net Barcode Reader for .NET | C# & VB . NET Guide in Reading QR ...
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