A Case of Abscess of the Right Temporosphenoidal Lobe, Associated with Left Hemiplegia and Hemianaesthesia due to Pressure on the Internal Capsule and Paralysis of the Right Third Nerve
Authors: H. A. Ballance
Journal: BMJ (1897)

disturbed, there is usually a marked degree of paraphasia or jargon aphasia and, it may be, complete motor aphasia, and agraphia; (3) internal speech and thought are always seriously impaired; and (4) in consequence of the extensive brain lesion the mental and intellectual faculties are in many cases more or less impaired, irrespective of the aphasic con- dition.In those cases in which the word deafness and word blindoess are incomplete, in which the motor speech defect (paraphasia) is only very slight, and in which the mental condition -of the patient is only slightly affected, the patient might pos- sibly be able to make a simple will, to give instructions for a -simple will and to execute a simple will (as in cases of pure word deafness in which the patient has never learned to mread); but such cases would require to be very carefully ,tested and scrutinised before the ability of the patient to ,make a will was admitted. THE: WILL-MAKING POWER OF PATIENTS AFFECTED WITH" TOTAL" APHASIA.In cases of total aphasia (word deafness, word blindness, 'notor vocal aphasia, and agraphia), the lesion is still more -extensive, and the mental disturbance still more profound.In these cases we cannot obmmunicate with the patient and he cannot communicate with us except by means of signs ,(pantomime).Everyone who has had experience in examining such cases knows how extremely difficult it is to make the patient understand even the simplest questions or requests.t, is obvious, therefore, that in cases of total aphasia the patient is incompetent to make a will.It must be remembered that in many cases of aphasia im- provement occurs in the course of time as the result of com j ensation.This is more particularly the case in young sub- iects, and in those cases in which the aphasia is due to embolic infarction; in which, in other words, the cerebral arteries and the brain tissues (other than the artery which is 'blocked by the infarction and the portion of brain tissue which has undergone softening in consequence of the infarction) are healthy.Hence, it does not follow that because a patient affected 'with complete sensory or even total aphasia is unable to make 4a will to-day he may not be able to make a will after several ,months have elapsed, that is, after sufficient time has elapsed lor compensation to take place. REFERENCES.It is probable, I think, that isolated agraphia may in some instances .occurastheresult of a lesion which interrupts the connectingfilbres passing from the visual speech centre (left angular gvrus) to the motor 'writing centre.' According to Dtjerine and Mirallid, there is always (I) -some derangement of the action of the auditory speech centre, which in mnany cases is shown by the fact that the patient, who is quite able to 'understand simple questions, seems unable to grasp the meaning of long -complicated spoken passages; and (2) some defect in the action of the 'motor speech centre.The usual defect is a slight degree of paraphasia.tn some cases spontaneous speech is more markedly affected.'1 Gazette