Broca meets Wernicke in a single case

• Follow-up study of a right-handed patient with aphasia after head trauma.
• Striking dissociation in aphasia profile between oral and written output.
• The profile shows the existence of a layered semantic system.

ObjectiveThe aim of this follow-up study is to describe the clinical and neuroradiological findings in an exceptional case presenting a marked discrepancy between oral and written language impairment.MethodsIn this 22-year-old right-handed patient in-depth neurolinguistic investigations were, conducted 5, 15 and 27 weeks after head trauma inducing a left frontotemporoparietal traumatic brain lesion. Oral as well as written communication is qualitatively analyzed.ResultsInitially, the aphasia profile was primarily characterized by a striking dissociation between oral and written output. In the acute phase, neurolinguistic findings were consistent with phonological jargon aphasia selectively affecting oral output. By contrast, no fluent aphasia symptoms were found in written output. The patient wrote slowly and intelligibly but written output was distorted by agrammatism. As such, typical fluent aphasia symptoms marked oral output, while nonfluent aphasia symptoms characterized written output. During longitudinal follow-up the dissociation between oral and written output resolved. Phonological errors and self-corrections in speech indicated an evolution to conduction aphasia.ConclusionsThe exceptional aphasia profile of this patient at 5 weeks posttrauma consists of a unique typological combination of typical fluent, Wernicke-like symptoms confined to oral output and typical nonfluent, Broca-like symptoms in writing. This case study shows the existence of a layered semantic system and an autonomic orthographic lexicon. Follow-up results revealed the impact of a controller system, by means of which the patient could sidestep disturbed phonology at the expense of communicative content.