Hindawi Publishing Corporation Case Reports in Medicine Volume 2010, Article ID 678060, 5 pages doi:10.1155/2010/678060 Case Report Variations in the Presentation of Aphasia in Patients with Closed Head Injuries Dara Oliver Kavanagh,1 Conor Lynam,1 Thorsten D u¨erk,1 Mary Casey,2 and Paul W. Eustace1 1 Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo, Ireland 2 Department of Radiology, Mayo General Hospital, Castlebar, Co Mayo, Ireland Correspondence should be addressed to Dara Oliver Kavanagh, dara kav@hotmail.com Received 11 October 2009; Accepted 5 January 2010 Academic Editor: Raul Coimbra Copyright © 2010 Dara Oliver Kavanagh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deﬁcits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with diﬀering forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome. 1. Introduction Closed head injury may result in a wide range of speech and language deﬁcits ranging from total loss of interpersonal communication to minor ﬂaws in word selection. They constitute a signiﬁcant workload in the acute hospital setting. Aphasia is a recognised yet under reported sequela of closed head injury. It is deﬁned as impairment of comprehension or production of language in written or spoken forms due to an acquired lesion of the dominant cerebral hemisphere. There are many types of aphasia ranging from nonﬂuent (Broca’s) aphasia, which is char- acterised by slow and incorrectly articulated speech to ﬂuent (Wernicke’s) aphasia in which the patient exhibits well-articulated speech, which lacks meaning. Broca’s area as described by the French pathologist Pierre Broca lies in areas 44 and 45 of Brodman in the inferior frontal gyrus of the dominant cerebral hemisphere, usually the left cerebrum. Injury to this area will produce a Broca’s aphasia [1]. Broca’s (motor) aphasia is associated with a deﬁcit in speech production or language output, often accompanied by a deﬁcit in written communication. The patient is aware of the impairment. Wernicke’s area, as described by the German Neurologist Karl Wernicke, lies in the posterior part of area 22 in the superior temporal, gyrus of the left cerebral hemisphere. Wernicke’s (sensory) aphasia is char- acterised by impaired comprehension of spoken and written words, associated with eﬀortless, articulated but paraphasic, speech and writing. Circumlocution can be a feature. More aggressive forms are characterised by incomprehensible speech. The patient is frequently unaware of the deﬁcit. The speech centres are linked by the arcuate fasciculus. This curves around the posterior end of the lateral ﬁssure within the white matter deep to the supramarginal gyrus [2]. The current series represents the experience of a district general hospital. Over 2000 annual referrals are evaluated in the emergency department. Of these, two hundred and seventy-one (range 251–317) met the criteria for acute admission to the Surgical Unit based on Advanced Trauma Life Support (ATLS) guidelines. Nine (range 9–12) patients were transferred to the National Neurosurgical Centre at Beaumont Hospital for more detailed neurosurgical man- agement. Herein, we report two diﬀering forms of aphasia following signiﬁcant closed head injuries with favourable outcomes.