Wernicke’s aphasia, frequently referred to as receptive aphasia, is due to a lesion in the posterior superior temporal region that involves the auditory association cortex and the angular and supramarginal gyri. When due to vascular disease, the ischemia is usually in the distribution of the inferior division of the MCA. Patients are relatively fluent, with a normal or even increased word output, but there is loss of the ability to comprehend the significance of spoken words or recall their meaning.(1-3) Speech production is effortless; phrase and sentence length and prosody are normal. Although speech is abundant, it is devoid of meaningful content. Paraphasias are frequent, resulting in incorrect or unintelligible words, unconventional and gibberish sounds, and senseless combinations. The speech abounds in neologisms. There may be circumlocution and an excess of small filler words. Patients cannot understand their own speech and are not aware of, and do not correct, errors in speaking. The frequent paraphasias and neologisms, combined with agrammatism, along with the high word output, may lead to completely unintelligible gibberish, termed jargon aphasia. Hughlings Jackson described this type of aphasia as “plentiful words wrongly used.”
Patients with Wernicke’s aphasia often have a visual field defect but no hemiparesis. Patients with acute Wernicke's aphasia may become agitated because of their comprehension difficulty. The agitated patient, speaking gibberish and with no gross neurologic deficit, is frequently thought to be psychotic.
The video shows a patient with Wernicke's aphasia, courtesy of Tactus Therapy.(4)
1. Campbell WW. DeJong's the neurologic examination, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.
2. Campbell WW. Clinical signs in neurology: a compendium. Philadelphia: Wolters Kluwer Health, 2016.
3. Alexander MP, Hillis AE. Aphasia. Handb Clin Neurol. 2008;88:287-309.
4. From Tactus Therapy, with permission. www.tactustherapy.com