macintosh
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Over a 5-week period, a previously healthy 55-year-old female has developed headaches,
progressively severe word-finding difficulty, and confusion. She speaks incoherently and
is unable to follow commands, repeat phrases, or name objects. What is the most likely
site of the lesion?
(A) frontal lobe
(B) temporal lobe
(C) occipital lobe
(D) parietal lobe
(E) cerebellum
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| yarab99
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A-frontal lobe ???
broca`s aphasia : inferior fontal gyrus
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| macintosh
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The question above is from the Kaplan Behavioral Sciences Lecture Notes. The given answer choice is "B", which I do not agree with. The question as I see it describes more impairment in the production of correct speech. The confusion may be because of the pateint's knowledge of her impairment. Additionally there is trouble repeating statements. All of these in my opinion point to a diagnosis of a lesion in the Broca's (motor speech) area, which lies in the frontal lobe.
So I choose choice "A". Please suggest your answer.
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| macintosh
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How did you post so fast yarab99. I was in the middle of writing my second post while you post your own answer. Yes I agree with you answer. Unfortunately the Kaplan does not.
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| yarab99
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ya i think so ,,cuz if they mean its wernicke`s...she would have fluant,,,word salad speech while broca is as te vegntee described
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| Tiff
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I don't think this a frontal lobe lesion. This looks more like a lesion of the arcuate fasciulus, conduction aphasia, which makes its hard to repeat speech. Arcuate fasciulus originates in the posterior temporal lobe to connect the Wernicke portion to the Broca area. So I agree with choice B.
Also to add, this doesn't sound like Brocas. Broca is agrammatic and not fluent. There's a broken speech and has notheing really to do with trouble repeating phrases.
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| new_n_lost
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But the confusion arises when they say she is having a severe word finding difficulty which is a symptom of Broca's Aphasia while in the next line where they mention repetition and naming is sort of in the Wernicke's Aphasia zone. And also she is speaking incoherently and is unable to follow commands which takes out Broca's because Auditory Comprehension is not intact. Most of the Wernicke patients have to be reminded that they are incoherent and are sort of frustrated or confused that no one can understand them.
So i would have to agree its Temporal Lobe. As the requirment for Wernicke's is sort of fullfilled.
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| new_n_lost
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Auditory comprehension is intact in Conduction Aphasia. So that is also ruled out.
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| Tiff
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new_n_lost wrote:
Auditory comprehension is intact in Conduction Aphasia. So that is also ruled out.
Your right. Good point. Lady can't follow commands and so does rule out arcuate fasciculus (conductive aphasia). In Wernickes, people also have problems repeating and can't comprehend and so seems like best diagnosis. Temporal lobe, home of Wernickes still remains best choice.
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| new_n_lost
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I have made a sort of cliff note for myself
Broca' = Halting speech, will say the right word but after couple of misses, can understand but not so much. Cant read and Cant write but usually if they do its like they speak so communication with them is tough. But they can understand you. Will have a hemiparesis and since they know that you cant understand them there will be an associated depression.
Expressive Language impaired but Auditory Comprehension near normal.
Wernicke = Language with no meaning, ramblings of an drunk, will not understand you but he might understand what he reads or if spoken to in very long pauses. He wont be able to comprehend or understand a single word but will talk to you like its the end of world. There is a sense of urgency in these patients. They cant wait to tell you whats on their mind and you all the while are like duh. Usually unrelated to Hemiparesis but will have a paranoid sort of actions as if you are the ones who cant understand them.
Expressive Language though preserved but meaningless and Auditory Comprehension impaired.
So Broca's is difficulty in speaking then Wernicke is difficulty in understanding.
The above is my understanding of the 2 scene as everyone is asked regarding them please add or correct things that i might have missed or mistyped.Thanks.
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| pr20
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nnl told us everything we need to know about wernicke's and broca's areas.
Spastic hemiparesis of contralateral upper limb or contralateral paralysis of the muscles of the lower face may be present in lesions of broca's area because broca's area is situated in the inferior frontal lobe just anterior to the primary motor cortex,and sometimes lesions in broca's area can extend posteriorly in to the primary motor cortex and cause associated paralysis.As wernicke's area is situated in the posterior temporal lobe,usually,there will be no associated problems of paralysis in lesions of wernicke's area.
Coming to the question,it is little confusing but most of the clues suggest to the choice B.
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| Ig F
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seems to be wernickes aphasia......nnl did a great job.....
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