Conduction aphasia

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Conduction aphasia
Broca's area and Wernicke's area
MeSH D018886

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Muneeb, MBBS[2] Synonyms and keywords: Dysphasia, Conduction; Associative Aphasia; Aphasia, Associative; Associative Aphasias; Dysphasias, Conduction; Aphasias, Associative; Conduction Aphasia; Conduction Dysphasias; Associative Dysphasias; Associative Dysphasia; Conduction Dysphasia; Dysphasias, Associative; Dysphasia, Associative; Aphasias, Conduction; Conduction Aphasias

Overview

Conduction aphasia, also called associative aphasia, is a relatively rare form of aphasia, thought to be caused by a disruption in the fiber pathways connecting Wernicke's and Broca's areas. The arcuate fasciculus has previously been implicated as this fiber bundle,[1] however more recent evidence suggests that the extreme capsule connects Wernicke's and Broca's areas[2].

Historical Perspective

Classification

  • [Disease name] may be classified according to [classification method] into [number] subtypes/groups:
  • [group1]
  • [group2]
  • [group3]
  • Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

Causes

The most common cause of conduction aphasia is damage to arcuate fasciculus lying deep to left supra marginal gyrus. Other common causes of conduction aphasia include damage to other brain areas including leftsuperior temporal gyrus, left primary auditory cortices, insula and left inferior parietal lobe. Damage can be caused by multiple insults including stroke, tumors, infections. [7][8][5]

Differentiating conduction aphasia from other Diseases

  • Conduction aphasia must be differentiated from other diseases that cause speech/language problems such as:[5]

Epidemiology and Demographics

  • The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
  • In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

  • Patients of all age groups may develop [disease name].
  • [Disease name] is more commonly observed among patients aged [age range] years old.
  • [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

  • [Disease name] affects men and women equally.
  • [Gender 1] are more commonly affected with [disease name] than [gender 2].
  • The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

  • There is no racial predilection for [disease name].
  • [Disease name] usually affects individuals of the [race 1] race.
  • [Race 2] individuals are less likely to develop [disease name].

Risk Factors

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
  • Prognosis depends upon the underlying etiology. If the conduction aphasia occurs as a result of stroke, then there is a probability of making a good recovery but persistent speech deficits may still remain. [5]

Diagnosis

Diagnostic Criteria

  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

History and Symptoms

Physical Examination

  • Physical examination is usually normal but may be remarkable for different findings depending upon the part of brain damaged. These may include:[9]

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with conduction aphasia.

X-ray

There are no x-ray findings associated with conduction aphasia.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with conduction aphasia.

CT scan

Brain CT scan may be helpful in the diagnosis of underlying etiology of conduction aphasia. As conduction aphasia is caused by damage in dominant hemisphere so ct scan can show stroke, tumor, infection or other pathologies of dominant hemisphere. [5]

MRI

Brain MRI may also be helpful in the diagnosis of the underlying etiology of conduction aphasia, as it can identify the pathologies of dominant hemisphere including stroke, infection, tumor etc. [5]

Other Imaging Findings

There are no other imaging findings associated with conduction aphasia.

Other Diagnostic Studies

There are no other diagnostic studies associated with conduction aphasia.

Treatment

Medical Therapy

Surgery

  • There is no surgical treatment directed for improvement of aphasia. However, surgery can be performed to eradicate certain causes leading to aphasia like tumors or infections. [5]

Prevention

Presentation

Patients with conduction aphasia show the following characteristics:

  • speech is fluent
  • comprehension remains good
  • oral reading is poor
  • Major Impairment in repetition
  • many phonemic paraphasias (phone substitution errors)
  • transpositions of sounds within a word ("television" → "velitision") are common.

To understand the symptoms, recall that Broca's area is associated roughly with expression, Wernicke's area with comprehension.

With both areas intact but the neural connections between them broken, there is the curious condition where the patient can understand what is being said but cannot repeat it (or repeats it incorrectly). This patient will also end up saying something inappropriate or wrong, realize his/her mistake, but continue making further mistakes while trying to correct it.

References

  1. Essentials of Human Physiology by Thomas M. Nosek. Section 8/8ch15/s8c15_14.
  2. Schmahmann, J. and Pandya, D. "Fiber Pathways of the Brain". Oxford University Press 2006
  3. Hickok G (September 2009). "The functional neuroanatomy of language". Physics of Life Reviews. 6 (3): 121–43. doi:10.1016/j.plrev.2009.06.001. PMC 2747108. PMID 20161054.
  4. Benson, D. Frank (1973). "Conduction Aphasia". Archives of Neurology. 28 (5): 339. doi:10.1001/archneur.1973.00490230075011. ISSN 0003-9942.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Acharya AB, Maani CV. "Conduction Aphasia - StatPearls - NCBI Bookshelf". statpearls publishing.
  6. Benson DF, Sheremata WA, Bouchard R, Segarra JM, Price D, Geschwind N (May 1973). "Conduction aphasia. A clinicopathological study". Archives of Neurology. 28 (5): 339–46. doi:10.1001/archneur.1973.00490230075011. PMID 4696016.
  7. Jiménez de la Peña MM, Gómez Vicente L, García Cobos R, Martínez de Vega V (2018). "Neuroradiologic correlation with aphasias. Cortico-subcortical map of language". Radiologia. 60 (3): 250–261. doi:10.1016/j.rx.2017.12.008. PMID 29439808.
  8. Damasio H, Damasio AR (June 1980). "The anatomical basis of conduction aphasia". Brain : a Journal of Neurology. 103 (2): 337–50. doi:10.1093/brain/103.2.337. PMID 7397481.
  9. 9.0 9.1 Swanberg, Margaret M.; Nasreddine, Ziad S.; Mendez, Mario F.; Cummings, Jeffrey L. (2007). "Speech and Language": 79–98. doi:10.1016/B978-141603618-0.10006-2.

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