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Chapter 21: Language

A 64-year-old woman presents with a reduction in fluency of speech with a serious deficiency in naming of objects and repetition of words when requested to do so. The patient’s writing is poor, and she also displays a hemiparesis. Comprehension of speech appears to be preserved. A magnetic resonance imaging (MRI) scan and overall neurologic examination reveal that the patient has a lesion. Which of the following regions is likely to contain the lesion?

A. Medial convexity of the premotor cortex

B. Frontal operculum and convexity

C. Supramarginal gyrus

D. Angular gyrus

E. Inferior parietal lobule

B. A lesion of the operculum and convexity of the frontal lobe (which lies rostral to the precentral gyrus of the left side of the cortex and is called the Broca area) results in aphasia. This form of aphasia is characterized by nonfluency in speech, as well as difficulty in word naming and repetition of words, while comprehension of speech is preserved. Frequently, such lesions extend beyond this region and include wide parts of the precentral gyrus, thus resulting in hemiparesis of the right side of the body. A lesion of the medial convexity of the premotor cortex would result in loss of motor functions mainly of the lower limb; lesions of the supramarginal gyrus or angular gyrus produce forms of aphasia in which fluency is preserved; and a lesion of the inferior parietal lobule might also produce a form of aphasia where fluency is preserved or a Gerstmann syndrome.

A 67-year-old woman is brought to a local hospital following complaints by her family because of recent difficulties that the patient has experienced in communicating with others. In particular, the patient has great difficulty in comprehending words and understanding simple commands. A neurologic examination confirms that the patient experiences difficulties in language comprehension, and an MRI reveals a cortical lesion. Which of the following regions was observed to be the locus of the lesion?

A. Medial convexity of the premotor cortex

B. Frontal operculum and convexity

C. Medial aspect of occipital cortex

D. Posterior aspect of superior temporal lobe

E. Superior (posterior) parietal lobule

D. A lesion of the posterior aspect of the superior temporal cortex, known as Wernicke area, results in a reduction in fluency in speech, and this form of aphasia is sometimes referred to as receptive aphasia. A lesion of the medial convexity of the premotor cortex would produce apraxic ...

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