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World Neurosurgery May 2024The Wernicke area, also known as Brodmann area 22, is located in the posterior segment of the superior temporal gyrus in the dominant hemisphere. Carl Wernicke, a German... (Review)
Review
The Wernicke area, also known as Brodmann area 22, is located in the posterior segment of the superior temporal gyrus in the dominant hemisphere. Carl Wernicke, a German neurologist, described this area in 1874. The life story of Carl Wernicke, a 19th-century medical genius, remains an inspiration for all neuroscientists even a hundred years later. We outline Wernicke's life story and academic achievements in neurosurgery, neurology, and psychiatry. We explore his remarkable ability to turn his many setbacks into steps forward, his controversial foray into psychiatry, and his wide-ranging set of contributions, including his work on external ventricular drainage for hydrocephalus and encephalopathy; his description of the eponymous Wernicke area; and his field-defining work on aphasia. This historical review attempts to bring to life a seminal figure in the neurosciences, providing an insight into his visionary thought process.
Topics: History, 19th Century; Humans; History, 20th Century; Wernicke Area; Germany; Neurosurgery; Neurology; Hydrocephalus
PubMed: 38417618
DOI: 10.1016/j.wneu.2024.02.103 -
Neurology Dec 2015The term "Wernicke's area" is most often used as an anatomical label for the gyri forming the lower posterior left sylvian fissure. Although traditionally this region... (Review)
Review
The term "Wernicke's area" is most often used as an anatomical label for the gyri forming the lower posterior left sylvian fissure. Although traditionally this region was held to support language comprehension, modern imaging and neuropsychological studies converge on the conclusion that this region plays a much larger role in speech production. This evidence is briefly reviewed, and a simple schematic model of posterior cortical language processing is described.
Topics: Comprehension; Humans; Language; Nerve Net; Speech; Wernicke Area
PubMed: 26567270
DOI: 10.1212/WNL.0000000000002219 -
Neurology Jan 2019To explore atrophy-deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary...
OBJECTIVE
To explore atrophy-deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary progressive aphasia (PPA).
METHODS
Cortical thickness in regions within and outside the classical Wernicke area, measured by FreeSurfer, was correlated with repetition and single word comprehension scores in 73 right-handed patients at mild to moderate stages of PPA.
RESULTS
Atrophy in the Wernicke area was correlated with repetition ( = 0.42, = 0.001) but not single word comprehension ( = -0.072, = 0.553). Correlations with word comprehension were confined to more anterior parts of the temporal lobe, especially its anterior third ( = 0.60, < 0.001). A single case with postmortem autopsy illustrated preservation of word comprehension but not repetition 6 months prior to death despite nearly 50% loss of cortical volume and severe neurofibrillary degeneration in core components of the Wernicke area.
CONCLUSIONS
Temporoparietal cortices containing the Wernicke area are critical for language repetition. Contrary to the formulations of classic aphasiology, their role in word and sentence comprehension is ancillary rather than critical. Thus, the Wernicke area is not sufficient to sustain word comprehension if the anterior temporal lobe is damaged. Traditional models of the role of the Wernicke area in comprehension are based almost entirely on patients with cerebrovascular lesions. Such lesions also cause deep white matter destruction and acute network diaschisis, whereas progressive neurodegenerative diseases associated with PPA do not. Conceptualizations of the Wernicke area that appear to conflict, therefore, can be reconciled by considering the hodologic and physiologic differences of the underlying lesions.
Topics: Aged; Aphasia, Primary Progressive; Comprehension; Female; Humans; Image Processing, Computer-Assisted; Language Tests; Longitudinal Studies; Magnetic Resonance Imaging; Male; Temporal Lobe; Vocabulary; Wernicke Area
PubMed: 30578374
DOI: 10.1212/WNL.0000000000006788 -
Neurologia Medico-chirurgica Jul 2016The neural basis of language had been considered as a simple model consisting of the Broca's area, the Wernicke's area, and the arcuate fasciculus (AF) connecting the... (Review)
Review
The neural basis of language had been considered as a simple model consisting of the Broca's area, the Wernicke's area, and the arcuate fasciculus (AF) connecting the above two cortical areas. However, it has grown to a larger and more complex model based upon recent advancements in neuroscience such as precise imaging studies of aphasic patients, diffusion tensor imaging studies, functional magnetic resonance imaging studies, and electrophysiological studies with cortical and subcortical stimulation during awake surgery. In the present model, language is considered to be processed through two distinct pathways, the dorsal stream and the ventral stream. The core of the dorsal stream is the superior longitudinal fasciculus/AF, which is mainly associated with phonological processing. On the other hand, semantic processing is done mainly with the ventral stream consisting of the inferior fronto-occipital fasciculus and the intratemporal networks. The frontal aslant tract has recently been named the deep frontal tract connecting the supplementary motor area and the Broca's area and it plays an important role in driving and initiating speech. It is necessary for every neurosurgeon to have basic knowledge of the neural basis of language. This knowledge is essential to plan safer surgery and preserve the above neural structures during surgery.
Topics: Brain Mapping; Humans; Language Development
PubMed: 27087195
DOI: 10.2176/nmc.ra.2016-0014 -
Eye (London, England) Jun 2022The incidence of bariatric surgery is increasing due to obesity being one of our top public health challenges. As such, bariatric-related ophthalmic changes are a... (Review)
Review
The incidence of bariatric surgery is increasing due to obesity being one of our top public health challenges. As such, bariatric-related ophthalmic changes are a potentially new clinical area of knowledge, with increasing published evidence on post-bariatric complications experienced by patients and identified by clinicians. We reviewed the available literature and summarised the different complications and potential recommendations. A search strategy was conducted with PubMed, Cochrane, Medline, Embase, Allied and Complementary Medicine and DH-DATA databases to look for papers answering our research question: "What are the ophthalmological complications for patients after bariatric surgery?". Our search gave a total of 59 relevant papers. Bariatric surgery, particularly subtypes that cause direct bypass of nutrients from the stomach, lead to nutritional deficiencies. Vitamin A, crucial for proper functioning of body systems and specialised cells, manifests ophthalmologically as corneal ulceration, nyctalopia, conjunctival xerosis and more. Thiamine levels are also depleted, leading to Wernicke's Encephalopathy. Pre-existing diabetic retinopathy is also noted to worsen sub acutely, although evidence is conflicting. Patients undergoing surgery to treat idiopathic intracranial hypertension would have reduced IOP and resolving papilloedema. Other comorbidities of obesity like HB levels, obstructive sleep apnoea, and metabolic syndrome also resolve post-surgery. History taking remains the cornerstone of medical practice. From the evidence, we suggest consideration of pre-surgery screening for ophthalmic pathology and post-operative monitoring of disease progression. Real-world data needs to continuously be analysed to create definitive management pathways that can help clinicians recognise ophthalmic complications early, improving patient outcomes.
Topics: Bariatric Surgery; Comorbidity; Humans; Obesity; Ophthalmologists; Sleep Apnea, Obstructive
PubMed: 34675393
DOI: 10.1038/s41433-021-01811-8 -
Brain : a Journal of Neurology Nov 2022Wernicke's area has been assumed since the 1800s to be the primary region supporting word and sentence comprehension. However, in 2015 and 2019, Mesulam and colleagues...
Wernicke's area has been assumed since the 1800s to be the primary region supporting word and sentence comprehension. However, in 2015 and 2019, Mesulam and colleagues raised what they termed the 'Wernicke conundrum', noting widespread variability in the anatomical definition of this area and presenting data from primary progressive aphasia that challenged this classical assumption. To resolve the conundrum, they posited a 'double disconnection' hypothesis: that word and sentence comprehension deficits in stroke-based aphasia result from disconnection of anterior temporal and inferior frontal regions from other parts of the brain due to white matter damage, rather than dysfunction of Wernicke's area itself. To test this hypothesis, we performed lesion-deficit correlations, including connectome-based lesion-symptom mapping, in four large, partially overlapping groups of English-speaking chronic left hemisphere stroke survivors. After removing variance due to object recognition and associative semantic processing, the same middle and posterior temporal lobe regions were implicated in both word comprehension deficits and complex non-canonical sentence comprehension deficits. Connectome lesion-symptom mapping revealed similar temporal-occipital white matter disconnections for impaired word and non-canonical sentence comprehension, including the temporal pole. We found an additional significant temporal-parietal disconnection for non-canonical sentence comprehension deficits, which may indicate a role for phonological working memory in processing complex syntax, but no significant frontal disconnections. Moreover, damage to these middle-posterior temporal lobe regions was associated with both word and non-canonical sentence comprehension deficits even when accounting for variance due to the strongest anterior temporal and inferior frontal white matter disconnections, respectively. Our results largely agree with the classical notion that Wernicke's area, defined here as middle superior temporal gyrus and middle-posterior superior temporal sulcus, supports both word and sentence comprehension, suggest a supporting role for temporal pole in both word and sentence comprehension, and speak against the hypothesis that comprehension deficits in Wernicke's aphasia result from double disconnection.
Topics: Humans; Connectome; Aphasia, Wernicke; Aphasia; Comprehension; Stroke; Brain Mapping; Magnetic Resonance Imaging
PubMed: 35727949
DOI: 10.1093/brain/awac219 -
Behavioural Neurology 2015Since the very beginning of the aphasia history it has been well established that there are two major aphasic syndromes (Wernicke's-type and Broca's-type aphasia); each... (Review)
Review
Since the very beginning of the aphasia history it has been well established that there are two major aphasic syndromes (Wernicke's-type and Broca's-type aphasia); each one of them is related to the disturbance at a specific linguistic level (lexical/semantic and grammatical) and associated with a particular brain damage localization (temporal and frontal-subcortical). It is proposed that three stages in language evolution could be distinguished: (a) primitive communication systems similar to those observed in other animals, including nonhuman primates; (b) initial communication systems using sound combinations (lexicon) but without relationships among the elements (grammar); and (c) advanced communication systems including word-combinations (grammar). It is proposed that grammar probably originated from the internal representation of actions, resulting in the creation of verbs; this is an ability that depends on the so-called Broca's area and related brain networks. It is suggested that grammar is the basic ability for the development of so-called metacognitive executive functions. It is concluded that while the lexical/semantic language system (vocabulary) probably appeared during human evolution long before the contemporary man (Homo sapiens sapiens), the grammatical language historically represents a recent acquisition and is correlated with the development of complex cognition (metacognitive executive functions).
Topics: Animals; Biological Evolution; Brain; Humans; Language; Linguistics; Semantics; Vocabulary
PubMed: 26124540
DOI: 10.1155/2015/872487 -
Cureus May 2021Awake craniotomy with intraoperative neurophysiological language mapping (INLM) is an established procedure for patients undergoing surgery to resection tumors in the...
Awake craniotomy with intraoperative neurophysiological language mapping (INLM) is an established procedure for patients undergoing surgery to resection tumors in the language cortex area. INLM and continuous neurophysiological monitoring allow assessment of the language function, which is not possible under general anesthesia. INLM of the brain areas provides a helpful tool to the operating surgeon in reducing the risks associated with tumor resection in the motor and language cortex. We present a literature review and the technical method used for INLM by utilizing direct electrical cortical stimulation. We also report the usefulness of INLM for evaluation of the language function during resection of cortical tumors, epilepsy foci, and arteriovenous malformations (AVMs) located near language areas. First, the central sulcus is identified by sensory mapping, followed by the motor cortex's identification by direct electrical cortical stimulation (DECS). Neurological assessment of the patient is done by auditory and visual feedback. The patient is asked to repeat numbers, days, words, sentences, read words, and name pictures during cortical stimulation. DECS may cause a slurring or speech arrest. Electrocorticography (ECoG) is also performed during cortical stimulation to identify any after-discharges. Examination of the patient occurs immediately after surgery, and then 24 hours, one week, six months, and 12 months postoperatively. Bipolar DECS for motor mapping with ECoG can safely and reliably be utilized to identify essential language areas with minimizing permanent language deficits and maximizing the extent of tumor resection.
PubMed: 34123657
DOI: 10.7759/cureus.14960 -
Scientific Reports Dec 2017Musical imagery is the human experience of imagining music without actually hearing it. The neural basis of this mental ability is unclear, especially for musicians...
Musical imagery is the human experience of imagining music without actually hearing it. The neural basis of this mental ability is unclear, especially for musicians capable of engaging in accurate and vivid musical imagery. Here, we created a visualization of an 8-minute symphony as a silent movie and used it as real-time cue for musicians to continuously imagine the music for repeated and synchronized sessions during functional magnetic resonance imaging (fMRI). The activations and networks evoked by musical imagery were compared with those elicited by the subjects directly listening to the same music. Musical imagery and musical perception resulted in overlapping activations at the anterolateral belt and Wernicke's area, where the responses were correlated with the auditory features of the music. Whereas Wernicke's area interacted within the intrinsic auditory network during musical perception, it was involved in much more complex networks during musical imagery, showing positive correlations with the dorsal attention network and the motor-control network and negative correlations with the default-mode network. Our results highlight the important role of Wernicke's area in forming vivid musical imagery through bilateral and anti-correlated network interactions, challenging the conventional view of segregated and lateralized processing of music versus language.
Topics: Adult; Auditory Cortex; Auditory Perception; Brain Mapping; Evoked Potentials, Auditory; Female; Humans; Imagery, Psychotherapy; Magnetic Resonance Imaging; Male; Music; Young Adult
PubMed: 29213104
DOI: 10.1038/s41598-017-17178-4 -
Journal of Neurology Apr 2022Eduard Gamper (1887-1938) was Head of the Department of Neuropsychiatry at the Charles University's German Faculty of Medicine in Prague. He had trained in Innsbruck,... (Review)
Review
Eduard Gamper (1887-1938) was Head of the Department of Neuropsychiatry at the Charles University's German Faculty of Medicine in Prague. He had trained in Innsbruck, where he undertook groundbreaking work on the midbrain in an anencephalic child and in a series of patients who had died from Wernicke's encephalopathy. Gamper identified the mamillary bodies as key in the performance of declarative memory. Considered an expert in memory disorders, he was chosen by the Medical Faculty in Innsbruck to provide expert opinion on the notorious case of Philipp Halsmann, who was suspected of murdering his father. Details of the case remained unresolved and Gamper's opinion caused both professional and political controversy. When in Prague, Gamper made great efforts to improve patient care and clinical services, establishing a special ward for patients with neurological conditions. This task was not nearly completed, when he and his wife died after their car drove over a cliff into the Walchensee in Bavaria. Rumours surrounded his death: that Gamper had just examined Adolf Hitler; that he was a political victim; that the Gestapo were behind the accident. After an investigation of the available evidence, we can report that an unusual 22 cm of snow fell in the area of the Walchensee on April 20, 1938, the day of the Gampers' deaths. We were unable to find any evidence for foul play in what appears to have been a tragic accident.
Topics: Accidents; Child; Ethnicity; History, 20th Century; Humans
PubMed: 34515855
DOI: 10.1007/s00415-021-10795-0