Gestures and pantomime do not improve communication. The patient does not seem to realize that his or her language is incomprehensible and may appear angry and impatient when the examiner fails to decipher the meaning of a severely paraphasic statement. In some patients this type of aphasia can be associated with severe agitation and paranoid behaviors. One area of comprehension that may be preserved is the ability to follow commands aimed at axial musculature. The dissociation between the failure to understand simple questions ("What is your name?") in a patient who rapidly closes his or her eyes, sits up,. | Chapter 027. Aphasia Memory Loss and Other Focal Cerebral Disorders Part 4 Gestures and pantomime do not improve communication. The patient does not seem to realize that his or her language is incomprehensible and may appear angry and impatient when the examiner fails to decipher the meaning of a severely paraphasic statement. In some patients this type of aphasia can be associated with severe agitation and paranoid behaviors. One area of comprehension that may be preserved is the ability to follow commands aimed at axial musculature. The dissociation between the failure to understand simple questions What is your name in a patient who rapidly closes his or her eyes sits up or rolls over when asked to do so is characteristic of Wernicke s aphasia and helps to differentiate it from deafness psychiatric disease or malingering. Patients with Wernicke s aphasia cannot express their thoughts in meaning-appropriate words and cannot decode the meaning of words in any modality of input. This aphasia therefore has expressive as well as receptive components. Repetition naming reading and writing are also impaired. The lesion site most commonly associated with Wernicke s aphasia is the posterior portion of the language network and tends to involve at least parts of Wernicke s area. An embolus to the inferior division of the middle cerebral artery and to the posterior temporal or angular branches in particular is the most common etiology Chap. 364 . Intracerebral hemorrhage severe head trauma or neoplasm are other causes. A coexisting right hemi- or superior quadrantanopia is common and mild right nasolabial flattening may be found but otherwise the examination is often unrevealing. The paraphasic neologistic speech in an agitated patient with an otherwise unremarkable neurologic examination may lead to the suspicion of a primary psychiatric disorder such as schizophrenia or mania but the other components characteristic of acquired aphasia and the absence of prior psychiatric
