Clinical Neurology and Neurosurgery 103 (2001) 123 – 126 Case report Aphemia: an isolated disorder of articulation Robert J. Fox *, Scott E. Kasner, Anjan Chatterjee, Julio A. Chalela Department of Neurology, Uniersity of Pennsylania Medical Center, Philadelphia, PA, USA Received 11 December 2000; received in revised form 27 April 2001; accepted 27 April 2001 Abstract Aphemia is a disorder with prominent speech abnormality. Since its description by Broca, there has been debate regarding the neuropsychological disorganization underlying aphemia: is aphemia an articulatory disorder or a language disorder? We describe a patient with markedly impaired articulation, but preserved receptive and written language function and buccal – facial coordination. The location of his stroke was in the left precentral gyrus, undercutting a small area of motor and premotor cortex. This case suggests that aphemia can occur as an isolated articulation deficit without language involvement or more widespread bulbar apraxia, and may be a severe form of apraxia of speech. © 2001 Elsevier Science B.V. All rights reserved. Keywords: Agraphia; Aphemia; Stroke www.elsevier.com/locate/clineuro 1. Introduction Aphemia, also termed simple aphasia, cortical anarthria, pure word mutism, or ataxic aphasia, is a rare articulatory disorder in which verbal motor output is grossly distorted. Broca coined the term aphemia in 1861 when he treated Leborgne, a stroke patient with complete articulatory failure. Broca described the disor- der as a defect in the faculty of articulated language, although his patient later progressed to have deficits involving the arm and leg. Shortly after its first descrip- tion, the term ‘aphemia’ was strongly criticized by Trousseau, who preferred the term ‘aphasia’ and claimed that the disorder extended beyond articulation to include comprehension, reading and writing. In 1887, Bastian revived interest in aphemia and agreed with Broca’s original description of aphemia as a disturbance in the organization of articulatory and motor aspects of speech, with intact grammar, reading, and writing. Marie and Dejerine continued the debate at the turn of the century by coining ‘anarthria’, thereby distinguishing between a linguistic disorder and a motor programming disorder (for a historical review, see Ref. [1,2]). Controversy has continued regarding the true neuropsychological disorganization of aphemia: is it a language disorder, or an articulatory disorder [3]? Most modern descriptions suggest that aphemia in- volves a dysfunction of written language in addition to verbal language, which contrasts with older descriptions. 2. Case report A 52 year old right-handed man with hypertension, diabetes mellitus, and dilated cardiomyopathy pre- sented with acute onset right facial weakness and in- ability to speak. On initial examination, he appeared anxious and frustrated. He was completely mute but tried to communicate desperately through gestures and facial contortions. Propositional and automatic speech were similarly affected. Comprehension of verbal and written language was completely normal. He was able to point to his needs using a pictorial communication board. He was able to cough, swallow, smile, and blow air without difficulty. He had mild right facial weakness but no limb weakness, sensory loss, or limb apraxia. A * Corresponding author. Present address: Mellen Center — U10, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel.: +1-216-4444232; fax: +1-215-4456259. E-mail address: foxr@ccf.org (R.J. Fox). 0303-8467/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved. PII:S0303-8467(01)00126-3