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(See also Chap 22) This term refers to certain disorders of language that result not from lesions of the cortical language areas themselves but from an apparent interruption of association pathways joining the primary receptive (sensory) areas to the language areas Included also in this category are aphasias due to lesions that separate the more strictly receptive parts of the language mechanism itself from the purely motor ones (conduction aphasia see below) and to lesions that isolate the perisylvian language areas, separating them from the other parts of the cerebral cortex (transcortical aphasias) The anatomic basis for most of these so-called disconnection syndromes is poorly de ned The theoretical concept, however, is an interesting one and emphasizes the importance of afferent, intercortical, and efferent connections of the language mechanisms The weakness of the concept is that it may lead to premature acceptance of anatomic and physiologic mechanisms that are overly simplistic The locale of the lesion that causes loss of a language function does not localize the language function itself, a warning enunciated long ago by Hughlings Jackson Nevertheless, the language disorders described below occur with suf cient regularity and clinical uniformity to be as useful as the more classic and common types of aphasia in revealing the complexity of language functions Conduction Aphasia As indicated earlier, Wernicke theorized that certain clinical symptoms would follow a lesion that effectively separated the auditory and motor language areas without directly damaging either of them Since then, a number of wellstudied cases have been described that conform to his proposed model of Leitungsaphasie (conduction aphasia), which is the name he gave it The characteristic feature is one of severely impaired repetition; the defect applies to both single words and nonwords The second essential feature is an affected but relatively preserved comprehension in comparison to Wernicke s aphasia In other respects, the features of conduction aphasia resemble those of a mild Wernicke s aphasia There is a similar uency and paraphasia in self-initiated speech, in repeating what is heard, and in reading aloud; writing is invariably impaired Dysarthria and dysprosody are usually lacking Speech output is normal or somewhat reduced As mentioned, comprehension is by no means perfect, but compared with one who has Wernicke s aphasia, the patient with conduction aphasia has relatively little dif culty in understanding words that are heard or seen and is aware of his de cit The lesion in the few autopsied cases has been located in the cortex and subcortical white matter in the upper bank of the left sylvian ssure, usually involving the supramarginal gyrus and occasionally the most posterior part of the superior temporal region The reason for classifying this aphasia as a disconnection syndrome.

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