Localization

Classically, conduction aphasia results from lesions of the arcuate fasciculus that disconnect receptive from expressive language regions. The arcuate fasiculus is a white matter tract that runs from Wernicke's area in the posterior superior temporal gyrus, arches around the sylvian fissure, and runs anteriorly to the inferior frontal lobe of Broca's region.

Many lesions that cause conduction aphasia not only involve the arcuate fasciculus but also include the supra-marginal gyrus and, sometimes, the posterior superior temporal gyrus, the left auditory complex, and portions of the insula. Most cases of conduction aphasia follow cerebral in-farcts of the dominant hemisphere involving thromboem-bolic occlusion of a posterior branch of the middle cerebral artery. It is relatively rare in comparison to other major aphasias (global, expressive, and receptive) because throm-boemboli usually lodge more proximally, causing more anterior or widespread infarcts.

Carl Wernicke postulated that a lesion of the arcuate fasciculus that disconnected receptive from expressive centers would produce a deficit in repetition, or conduction aphasia. Others proposed that a single cortical center was responsible for integration of receptive and expressive regions yet was independent of them (Goldstein, 1948). This hypothesis lead to adoption of the alternative term central aphasia because the specific cortical region mediated central or inner speech.

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