Ask this patient a few questions.



See Case 48 (pp 147-8).


Patient has difficulty in finding the appropriate words, comprehension is intact and repetition may or may not be intact.

Proceed as follows:

Tell the examiner that you would like to carry out a neurological examination of the patient for a right-sided stroke.


This patient has expressive dysphasia (lesion) due to a right-sided stroke (aetiology).


Where is the lesion?

In Broca's area, which is located in the posterior portion of the third left frontal gyms. It is the motor association cortex for face,

tongue, lips and palate. It contains the motor patterns necessary to produce speech.

How would you manage this patient?

· CT head scan to localize the affected area.

· Aspirin.

· Referral to the speech therapist.

· General rehabilitation of a patient with stroke.

Pierre Paul Broca (1824-1880) was Professor of Surgery in Paris. His notable achievements were in anthropology and his

suggestion of cerebral localization of speech was first made at a French Anthropological Society meeting in 1861. He is reported to

have described muscular dystrophy (before Duchenne), venous spread of cancer (before Rokitansky) and rickets as a nutritional

disorder (before Virchow).