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Stroke Service, Departments of Neurology and Neuroradiology, Massachusetts General Hospital: Massachusetts Rehabilitation Hospital; and the Harvard Medical School, Boston, Massachusetts.
The speech disturbance resulting from infarction limited to the Broca area has been delineated; it differs from the speech disorder called Broca aphasia, which results from damage extending far outside the Broca area. Nor does Broca area infarction cause Broca aphasia. The lesions in 20 cases observed since 1972 were documented by autopsy, computerized tomography, or arteriogram; the autopsy records from the Massachusetts General hospital for the past 20 years and the published cases since 1820 were also reviewed. The findings suggest that infarction affecting the Broca area and its immediate environs, even deep into the brain, causes a mutism that is replaced by a rapidly improving dyspraxic and effortful articulation, but that no significant disturbance in language function persists. The more complex syndrome traditionally referred to as Broca aphasia, including Broca's original case, is characterized by protracted mutism, verbal stereotypes, and agrammatism. It is associated with a considerably larger infarct which encompasses the operculum, including the Broca area, insula, and adjacent cerebrum, in the territory supplied by the upper division of the left middle cerebral artery.
Dr. Mohr's address is Department of Neurology, Massachusetts General Hospital, Boston, MA 02114.
This paper was supported by Grants NS 10828-01A1, HS 00188, and the Godfrey Hyams Trust.
A shorter version of this paper was presented at the annual meeting of the American Academy of Neurology, Bal Harbour, Florida, May 1975.
Accepted for publication July 22, 1977.
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