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tivating the left motor area crosses the corpus callosum more anteriorly Spontaneous writing and writing to dictation are also intact because the language areas, including the angular gyrus, Wernicke s and Broca s areas, and the left motor cortex, are intact and interconnected, but after a delay, the patient is unable to read what he has previously written (unless it was memorized) This is the syndrome of alexia without agraphia mentioned earlier and discussed further on page 422 A lesion that is limited to the anterior third of the corpus callosum (or a surgical section of this part, as in patients with intractable epilepsy) surprisingly does not result in an apraxia of the left hand A section of the entire corpus callosum does result in such an apraxia, ie, a failure of only the left hand to obey spoken commands, the right one performing normally, indicating that the ber systems that connect the left to the right motor areas cross in the corpus callosum posterior to the genu (but anterior to the splenium) Object naming and matching of colors without naming them are also done without error However, blinded, the patient cannot name a nger touched on the left hand or use it to touch a designated part of the body Of interest to the authors is the fact that one sometimes encounters patients with a lesion in all or some part of the corpus callosum without being able to demonstrate any aspect of the aforementioned disconnection syndromes Is the lesion incomplete Probably not in every case Notable is the observation that in some patients with a congenital agenesis of the corpus callosum (a not uncommon developmental abnormality), none of the interhemispheral disconnection syndromes can be found One can only suppose that in such patients information is transferred by another route perhaps the anterior or posterior commissure or that dual dominance for language and praxis was established during early development (See a review of this subject by Lassonde and Jeeves) In addition to alexia without agraphia, the following intrahemispheral disconnections have received the most attention They are mentioned here only brie y and are considered in more detail in the following chapter 1 Conduction (also called central ) aphasia The patient has severely impaired repetition, but uent and paraphasic speech and writing and relatively intact comprehension of spoken and written language Wernicke s area in the temporal lobe is putatively separated from Broca s area, presumably by a lesion in the arcuate fasciculus or external capsule or subcortical white matter However, most often the lesion is in the supramarginal gyrus, as discussed in Chap 23 2 Ideomotor ( sympathetic ) apraxia in Broca s aphasia By destroying the origin of the bers that connect the left and right motor association cortices, a lesion in the more anterior parts of the corpus callosum or the subcortical white matter underlying Broca s area and contiguous frontal cortex causes an apraxia of commanded movements of the left hand (see Chap 3 and earlier discussion) 3 Pure word-deafness Although the patient is able to hear and identify nonverbal sounds, there is loss of ability to discriminate speech sounds, ie, to comprehend spoken language The patient s speech may be paraphasic, presumably because of the inability to monitor his own speech This defect has been attributed to a subcortical lesion of the left temporal lobe, spanning Wernicke s area and interrupting also those.

auditory bers that cross in the corpus callosum from the opposite side Thus there is a failure to activate the left auditory language area (Wernicke s area) Bilateral lesions of the auditory cortex have the same effect (see Chap 23)

In the study of focal cerebral disease, there are two complimentary approaches the clinical-neurologic and the neuropsychologic The rst consists of the observation and recording of qualitative changes in behavior and performance and the identi cation of syndromes from which one may deduce the locus and nature of certain diseases The second consists of recording a patient s performance on a variety of psychologic tests that have been standardized in a large population of age-matched normal individuals These tests provide data that can be graded and treated statistically An example is the deterioration index, deduced from the difference in performance on subtest items of the Wechsler Adult Intelligence Scale that hold up well in cerebral diseases (vocabulary, information, picture completion, and object assembly) and those that undergo impairment (digit span, similarities, digit symbol, and block design) A criticism of this index and others is the implicit assumption that cerebrocortical activity is a unitary function However, it cannot be denied that certain psychometric scales reveal disease in certain parts of the cerebrum more than in others These tests allow comparison of the patient s de cits from one point in the course of an illness to another Walsh has listed the ones that he nds most valuable In addition to the Wechsler Adult Intelligence Scale, Wechsler Memory Scale, and an aphasia screening test, he recommends the following for quantifying particular psychologic abilities and skills: I Frontal lobe disorders A Milan Sorting Test, Halstead Category Test, and Wisconsin Card-Sorting Test as tests of ability to abstract and shift paradigms B The Porteus Maze Test, Reitan Trail-Making Test, and