Broca's aphasia

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Aphasia is an acquired disorder of language, including various combinations of impairment in the ability to produce, understand and repeat speech, as well as defects in the ability to read and write.(1-3) Using bedside testing, the aphasias have been classified in several ways. A commonly used scheme includes Broca's, Wernicke's, conduction, global, transcortical (motor, sensory and mixed) and anomic. A key distinguishing feature is fluency. Nonfluent speech is laborious, with single words, short phrases, pauses and hesitation. In severe aphasia, the patient may be unable to utter a single word or endlessly repeat a monophasia. Aphasia is a disorder of language, as opposed to dysarthria, which is a disorder involving the mechanics of speech production.

Broca’s (expressive, motor or anterior) aphasia is a nonfluent type of aphasia due to a lesion involving the anterior perisylvian speech areas in the posterior inferior frontal region. Patients have labored, uninflected, nonfluent spontaneous speech with a decreased amount of linguistic output: few words, short sentences and poor grammar. In severe Broca’s aphasia, the speech consists of nouns and substantive verbs produced with great effort. There is a tendency to leave out nonessential words such as adjectives, adverbs, and functor words (telegraphic speech). Speech comprehension is relatively unimpaired.

The patient in the video suffered a large hemorrhagic stroke involving the left hemisphere and has been left with a right spastic hemiplegia and Broca's aphasia. He is severely nonfluent with very sparse, effortful and largely unintelligible verbal output. Comprehension is well preserved; he follows simple commands and clearly understands what is said to him. He can recite overlearned material, the days of the week, but can't spontaneously give the correct day. He has a repetitive utterance, or monophasia, something to the effect of "I bad." He is very aware of and frustrated by his speech limitations.


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.