NEUROLOGY

Aphasias

Three bedside tests classify every aphasia. Fluency, comprehension, repetition. That's the whole game.

THE CASE

Can You Name This Aphasia?

Read the vignette. Pick your diagnosis before scrolling.

A 69-year-old right-handed man presents with 3 months of difficulty speaking. In conversation, he speaks fluently with normal grammar and understands everything you say. When you ask him to repeat "no ifs, ands, or buts," he says: "No iffs... antsss... or buts... or buts..." He tries again: "Sintelmarvin... kinterflargin... kantolargen... kindergarten!" He seems frustrated but knows the words are wrong.

Which type of aphasia does this patient most likely have?
A. Broca aphasia
B. Wernicke aphasia
C. Conduction aphasia
D. Transcortical motor aphasia
E. Global aphasia

The key to that case? Three bedside tests. That's all aphasia classification requires. Every single type falls into a unique pattern of:

🔑 Fluency (can they produce words smoothly?) · Comprehension (do they understand you?) · Repetition (can they repeat a phrase?)

Every aphasia you will ever see in clinical practice boils down to a unique combination of those three tests. Learn the table below and you can classify any aphasia in under 10 seconds.

⚠️
Board Trap: Laterality
All language areas are in the left hemisphere for 95% of right-handed people and 70% of left-handed people. A right MCA stroke in a right-handed person causes hemispatial neglectThe patient ignores one entire side of space. They might not eat food on the left side of their plate, or fail to notice people approaching from the left. It is a parietal lobe problem, not a language problem., NOT aphasia. If the stem says "right-handed" and the lesion is on the right, aphasia is WRONG.

THE THREE TESTS

Classify Every Aphasia

Tap each cell to guess the answer before it is revealed. Can you get them all?

Aphasia Fluency Comprehension Repetition Lesion
BrocaExpressive
WernickeReceptive
ConductionDisconnection
GlobalEverything down
Transcortical MotorLike Broca + repeat
Transcortical SensoryLike Wernicke + repeat
Mixed TranscorticalEcholalia
0 / 28 cells revealed

See the pattern? Repetition is the fork in the road. If repetition is impaired, you are dealing with a "classic" aphasia (Broca, Wernicke, conduction, global). If repetition is intact, you are looking at a transcortical type.

🔑Transcortical = They can repeT. All three T's.

Why? The arcuate fasciculusThe white matter tract connecting Broca area (frontal) to Wernicke area (temporal). It is the "telephone wire" between understanding language and producing language. When it is intact, repetition works. is the bridge between Broca and Wernicke. Classic aphasias damage this bridge directly (conduction) or damage one endpoint (Broca, Wernicke) or both (global). Transcortical aphasias spare this bridge because they hit the watershed zones around it, not the bridge itself. So the bridge still works. And if the bridge works, you can repeat.

🔑Watershed = border zone between two arterial territories. Like the dry land between two sprinklers. First area to die in a drought (hypoperfusion).
⚠️
Board Trap: Conduction vs Transcortical
Both conduction and transcortical sensory are fluent with ONE test impaired. The difference: conduction breaks repetition (arcuate fasciculus damaged), while transcortical sensory breaks comprehension (posterior watershed damaged, arcuate intact). If the stem mentions phonemic paraphasiaThe patient gets the word structure right but swaps individual sounds. "Kindergarten" becomes "kinterflargin." They KNOW it is wrong and keep trying. This is different from semantic paraphasia (substituting a related word, like "chair" for "table")., that is conduction. If they can repeat perfectly but have no idea what the words mean, that is transcortical sensory.

ELIMINATION ROUND

Name That Aphasia

A patient walks in with a specific pattern. Eliminate the wrong types one by one.

Loading clue...
Global
Everything broken
Broca
Non-fluent, understands
Wernicke
Fluent word salad
Conduction
Can't repeat
Loading clue...
Broca
Non-fluent, understands
TC Motor
Like Broca + repeat
TC Sensory
Like Wernicke + repeat
Mixed TC
Echolalia
Medically reviewed by Kaitlyn Cocuzzo, MD and Fatima Ali, DO · Last reviewed June 2026
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