Aphemia. Clinical-anatomic correlations

A syndrome of dysarthria following the appearance of small left frontal-lobe lesions has been recognized for many years but identified by numerous labels. Varied terminology has led to confusion in the literature and inadequate recognition of this syndrome as a distinctive clinical entity. We gathered clinical and anatomic (computed tomographic) data on four patients with this dysarthric syndrome and reviewed cases from the literature that contained sufficient clinical and anatomic data for comparison. These patients had a distinctive syndrome of dysarthria without aphasia, caused by small lesions of the motor system for articulation: pars opercularis, inferior prerolandic gyrus, or white matter deep to those regions. This syndrome should be distinguished from Broca's aphasia, Broca's area aphasia, transcortical aphasia, and subcortical aphasia. Aphemia is not mild Broca's aphasia; it is severe dysarthria, at times in the setting of transient Broca's aphasia.