NEUROANATOMY OF LANGUAGE

SPEECH:
Speech is the vocalized form of human communication.
The formation of speech is unique to human, with the use of phonetics (using
consonants and vowels)
Based upon the syntactic combination of lexicals and names that are drawn from very
large vocabularies (usually about 10,000 different words! uniqueness of our memory
bank
"ach spo#en word is created out of the phonetic combination of a limited set of vowel
and consonant speech sound units. In order to produce sounds, we need to use vowels.
Without vowels, sounds are nonsense because we cannot prolong the consonants.
The production of speech must be in harmony with the works of entral !ervous "ystem, the articulatory
system and as well as the respiratory system. Without the respiratory system, it is very hard to produce
sounds. #s the person e$hale, it results in the vibration of your vocal cords. Without the articulatory system,
sound is nonsense. It consists of the union of the teeth, the movement of the tongue, the si%e of your
resonators (cavities that are located in your facial area, oral cavity and ma$illary sinus). These chambers will
tend to amplify the sound. &our articulatory system which includes your teeth and your tongue, are the
structures that will give rise to your vowels and your consonants. With the aid of the !", the speech or the
language is being understood by an individual so that the message becomes a two way process provided
that we can understand that common language. 'on(t label a patient as aphasic if you(re using the )ilipino
language while talking to a *erman. In clinical history, it is very important to take note of the !ationality of
the patient as well as if they are speaking in different dialects.
LANGUAGE:
$t is an arbitrary and abstract way to represent thought processes by means of
sentences and to present concepts or ideas by means of words. (figures for
hieroglyphics)
%efers to the specific human capacity for ac&uiring and using complex systems of
communication (nice to know according to doc
'he scientific study of language in any of its senses is called ()inguistics*
DOMINANT LANGUAGE HEMISPHERE
What particular aspect in your skill will dictate your dominant hemisphere+ ,andedness.
If you are right-handed, your dominant hemisphere is the left but this is only true for ./0
of the population.
+ost components of the language system are located in the left hemisphere (provided
that you are a right-handed individual).
,early all and -./ of left!handers have right cerebral dominance
0 disturbance in language includes disturbances in the ability to comprehend (decoding
and.or program (coding the symbols necessary for communication.
'ecoding- the brain cannot process what is brought to the wernicke(s area
oding- you have difficulty e$pressing a particular languange
CORTICAL LANGUAGE AREAS
1. 1ernic#e2s 0rea
-. Broca2s 0rea
/. 'he 0rcuate 3asciculus

I. WERNICKES AREA
,amed after 4erman ,eurologist, 5arl 1ernic#e
"xtensive region that includes the superior temporal gyrus (0rea -- and the
angular gyrus (0rea /6
#rea 11 is for comprehension of spoken language while #rea 2. is for
comprehension of written language
0rea -- is responsible for comprehension of spo#en language
,ow do we comprehend the spoken language+ &ou need the help of the
visual pathway. Isn(t it that the Wernicke(s area is located beside the occipital
lobe+
0rea -- is responsible for comprehension of written language
Spo#en language is perceived in primary auditory area ('ransverse 'emporal
4yrus.7eschl 4yrus. 0rea 81 and 8- and transmitted to 1ernic#e2s 0rea
The sensory part of speech.
The clue for the location of this is the transverse temporal gyrus. &ou have to
open the lateral sylvian fissure in order to see this which is embedded at the
superior part of the superior temporal gyrus. 3ehind the transverse temporal
gyrus is the Wernicke(s area. &ou have to hear first, in order to understand.
II. BROCAS AREA
,amed after the 3rench 9athologist, 9ierre Broca
%egion in the frontal lobe which includes the opercular (0rea 88 and
triangular gyrus (0rea 8: of inferior frontal gyrus.
%eceive inputs from 1ernic#e2s 0rea via the 0rcuate 3asciculus
1ithin the Broca2s 0rea, a coordination program for vocalization is formulated
which is transmitted in the face, tongue, pharynx and larynx of the motor
cortex for speech execution.
3roca(s area is the motor part of speech. If we place the homunculus in #rea
4, the head and neck musculature is located near the sylvian fissure and
beside the 3roca(s area.
REMEMBER BMWs!!! (Broca's for Motor, Wernicke's for Sensory)
III. ARCUATE FASCICULUS
$t is a long association bundle that lin#s the 1ernic#e2s 0rea to Broca2s 0rea
;amage to 0rcuate fasciculus is associated with impairment of repetition of
spo#en language (but the patient can still understand)
# band of white matter that connect your Wernicke(s area to 3roca(s area
#!' IT I" !5T T,6 5T,67 W#& #758!'999 The direction of the stimulus
is from Wernicke(s it will pass the arcuate fasciculus then it will go to 3roca(s
area.
Role of Non-Do!n"n# He!$%&e'e !n S%ee(&:
0lthough it is believed that the dominant hemisphere is the one responsible for speech
production, the non!dominant hemisphere is metabolically active during speech. 'hese areas
are believed to be concerned with melodic function of speech (9rosody
0prosody < )esions involving the right hemisphere render speech amelodic.
LANGUAGE DISORDERS
APHASIA
3rom the 4ree# word (0* without, (9hasia* speech
#ka 0phemia
)oss or impairment of the ability to produce and.or comprehend language
;ue to damage to the language centers! Wernicke(s #rea, 3roca(s #rea and #rcuate
)asciculus (Stro#e, =erebral 'umors, ;egenerative ;iseases
=lassification>
o ;isturbance in receiving and decoding symbolic materials
o ;isturbance in central processes of meaning, word selection and message
formulation
o ;isturbance in expressing symbolic materials
/ 0reas 0ffected by 0phasia> (REMEMBER: FoRCe)
o FLUENCY
Spea#ing with normal grammar, syntax rate, intonation and stress
,on!fluent>
9roblem of 0grammatism
Speech is difficult to initiate, labored and halting. $ntonation
patterns are deficient
)anguage is reduced to dis?ointed words (in tagalog: barok)
o COMPREHENSION
0bility to understand language (verbal or written
'5 !5T ;#36; &587 <#TI6!T WIT, #<,#"I# I) T,#T <#TI6!T I"
!5T #W#76 5) &587 !#TI=6 ;#!*8#*69
o REPETITION
Saying by one individual of the spo#en vocalization made by another
individual (the only ability that can be done by lower form of animals like
parrots)
TYPES OF APHASIA
). GLOBAL APHASIA (REMEMBER: globA)
0ll parameters (fluency, comprehension and repetition are impaired
!on-fluent type, comprehension is impaired and has no ability to repeat spoken
language
0lmost totally absent speech
Stereotypic utterances
@AB =0,,A' 4$C" 7A+" $,S'%B='$A,S 3A% '7"S" 90'$",'SDDD
;o not label your patient with global aphasia if your patient is mute or deaf
*. ISOLATION + MI,ED TRANSCORTICAL APHASIA (REMEMBER: !R" in !solation, it is
only t#e Re$etition t#at is nor%al)
$nability to comprehend what is being said
;ifficulty in creating speech with meaning without affecting the ability to recite what has
been said
They have the repetition ability, they are like parrots
-. BROCAS APHASIA (REMEMBER: BC si BEA" in Broca's, Co%$re#ension is intact
an& it is an E'$ressi(e A$#asia)
3luency and repetition are impaired but comprehension is intact
The problem is musculatory control over the articulatory muscles
"xpressive aphasia (can understand but cannot spea#
)imited verbal output
$mpaired articulatory agility
Stereotyped grammar
&58 #! *I=6 I!"T78TI5!" but don(t let the patient repeat your instructions
.. TRANSCORTICAL MOTOR APHASIA (REMEMBER: )aMA CoRrect" in )ranscortical
Motor A$#asia, co%$re#ension an& re$etition are nor%al)
3luency is impaired but comprehension and repetition are normal
0#a 0dynamic 0phasia
$nvolves the structures surrounding Broca2s 0rea, the BrocaEs 0rea is still intact
/. WERNICKES APHASIA (REMEMBER: W#at t#e F*ckeR" Wernicke's, Fl*ency is
nor%al an& is of Rece$ti(e ty$e)
3luency is normal but comprehension and repetition are impaired
%eceptive 0phasia (=an spea# but cannot understand
=opious verbal output
,eologisms and ?argon, if severe
,ormal articulatory agility
,aming is impaired
&58 #!!5T *I=6 I!"T78TI5!" T5 <#TI6!T" WIT, W67!I>6(" #<,#"I#
#ccording to doc, ?salita ng salita pero walang sense?
0. TRANSCORTICAL SENSORY APHASIA (REMEMBER: )aSA si Fat#eR" in )ranscortical
Sensory A$#asia, Fl*ency an& Re$etition is nor%al)
3luency and repetition are normal, comprehension is impaired
=onversation and comprehension resembles 1ernic#e2s 0phasia
"xtreme difficulty with nouns
The structures surrounding the Wernicke(s are impaired but the Wernicke(s is still intact
1. CONDUCTION APHASIA (REMEMBER: CFCs" !n Con&*ction a$#asia, Fl*ency an&
Co%$re#ension are nor%al)
3luency and comprehension are normal, repetition is impaired
4ood articulation and phrase length
0cute awareness of errors
@AB =0, 4$C" $,S'%B='$A,S 'A '7" 90'$",'
2. ANOMIC APHASIA
0ll parameters are normal
Severe word finding deficits
0ppropriate grammatical forms
@ental block
<roblems with naming parts

SITE OF LESION
). ANTERIOR LESIONS- Non-fl3en# "%&"$!"
! involving the frontal lobe
! BrocaEs, 'ranscortical motor, $solation, 4lobal
" (REMEMBER: B!+ )iMe si A,,)
*. POSTERIOR LESIONS- Fl3en# "%&"$!"
! involving the parietal, temporal and sometimes the occipital lobe
! 1ernic#eEs, =onduction, 'ranscortical sensory, 0nomic
" (REMEMBER: -.WER CA)S an& F/)
B%A=0ES +=0, frontal lobe
'%0,S=A%'$=0) +A'A% 0=0, prefrontal
1"%,$=5"ES +=0, 'emporal lobe
'%0,S=A%'$=0) S",SA%@ 9=0, 9arietoccipital
=A,;B='$A, +=0, arcuate fasciculus
0,A+$= +=0, angular gyrus
4)AB0) +=0, multilobes