A 74-year-old man with a history of atrial fibrillation on warfarin is admitted to the hospital for progressively increasing headaches and speech dysfunction for the past 10 days. The patient’s wife informs the physician that the patient complained of a headache that started insidiously almost 10 days ago following a head trauma and has been progressively getting worse. Upon questioning the patient, he answers back fluently and says: “A plane drink and I can not shower for coffee feet the trash”. CT scan of the brain reveals a subdural hematoma. Which of the following brain regions is most likely responsible for the patient’s speech dysfunction?
1) Superior temporal gyrus
2) Inferior frontal gyrus
3) Superior temporal and frontal gyri
4) Arcuate fasiculus
5) Area between the supplementary motor area and the frontal perisylvian speech zone
Ans:
The patient’s presentation of progressively worsening headache and sensory aphasia following trauma is suggestive of chronic subdural hemorrhage. The patient’s age, symptoms, use of anticoagulants, and history of mild trauma support the diagnosis, which is confirmed by the findings on CT scan. The patient’s speech dysfunction is manifested by intact fluency and impaired comprehension, which is characteristic of Wernicke’s aphasia. Wernicke’s aphasia is also known as sensory or receptive aphasia. There are several types of aphasia:
Wernicke’s aphasia: impaired comprehension, intact speech fluency, and impaired repetition.
Broca’s aphasia: intact comprehension, impaired speech fluency, and impaired repetition.
Global aphasia: impaired comprehension, impaired speech fluency, and impaired repetition.
Conduction aphasia: intact comprehension, intact speech fluency, and impaired repetition.
Shown below is an image depicting the different areas involved in aphasias
