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December 1989

On Cerebral Metabolism and Aphasia

Author Affiliations

Department of Neurology University of Maryland 22 S Greene St Baltimore, MD 21201

Arch Neurol. 1989;46(12):1271-1272. doi:10.1001/archneur.1989.00520480013009

To the Editor.  —Metter et al1 and Kempler et al2 recently characterized the regional cerebral metabolic profiles of the perisylvian aphasias, strictly using the Western Aphasia Battery3 classification scheme. For illuminating the physiologic processes of neurolinguistic disturbances, this is unsatisfactory, since the Western Aphasia Battery uses inconsistent measures of fluency and repetition, while the comprehension assessment does not exclude errors arising from defective motor planning, spatial inattention, or visual imperception.The authors also predicted hypometabolic Broca's area in conduction aphasia from interruption of the arcuate fasciculus, but observed this in only half their patients2; therefore, they questioned the disconnection hypothesis.4 This is unwarranted, since the hypothesis does not predict hypometabolic Broca's area. In conduction aphasia this area continues to organize speech output via input from other regions,5 with no fluency change. The authors' assumption that resting patterns in metabolic studies may reflect those in