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Paul Broca genera un avance científico afirmando que el cerebro se encuentra dividido en base a funciones.
Descubriendo que el hemisferio izquierdo es el encargado del lenguaje.

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Biografía de Paul Broca y sus aportaciones a las neurociencias. 

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PAUL BROCA Y SUS APORTACIONES A LA NEUROCIENCIA. 

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PAUL BROCA Y SUS APORTACIONES A LA NEUROCIENCIA. 

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Academia Nacional de Medicina de Colombia - Órgano consultor del Gobierno Nacional en temas de salud y educación médica.

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Paul Broca y sus aportes a la Neurociencia - Academia Nacional de Medicina de Colombia

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Por Leonardo Palacios Sánchez. Paul Broca (1824-1880) realizó importantes aportes en varias disciplinas, particularmente en medicina y antropología. Fue médico y cirujano, patólogo, uno de los fundadores de la neurología y antropología. Obtuvo el título de doctor en medicina a la temprana edad de 20…

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Louis Victor Leborgne may be an unfamiliar name to many of us. The life of a patient who spent more than 21 years in the hospital speaking a single word has made a remarkable contribution to our understanding of human speech. Leborgne was a patient under the care of Pierre Paul Broca, a brilliant French surgeon, an anthropologist, and an explorer of the human mind. We owe it to Leborgne and the great minds of that time to have made concepts regarding the biology of human speech, a common knowledge today. MacDonald Critchley ¹ has rightly remarked that if Leborgne had sought admission for his phlegmon in any other hospital of Paris other than the Bicêtre, the history of aphasiology would have been entirely different. ² Jean Baptist Bouillard would later call Broca "the St. Paul of the new doctrine" of the laterality and localization of human speech. Leborgne's brain was preserved by Broca and can still be seen at the Musee Dupuytren Museum in Paris.

Leborgne was born 21 July, 1809 in the French town of Moret sur-Loing. ³ His father was an elementary school teacher. He had 5 siblings. It is speculated that he was illiterate, but examination of his marriage certificates have revealed that he was at least partially literate. He worked as a "formier" or hat form maker.3, 4 Leborgne's health problems started in his youth. He began having epileptic fits. He continued to work until 30 years of age, when the problem with his speech began. At the age of 30, Leborgne lost the ability to speak. Expecting that the condition was temporary and would recover, he did not seek medical advice. He was then admitted to Bicêtre Hospital's psychiatry division for evaluation of his complaints, which did not improve. He remained unmarried and could not be discharged to the care of close relatives. Leborgne continued to spend the rest of his 21 years in the hospital ³ (Figure 1). He remained in the psychiatry division for several years. It was only toward the end of his life that he was transferred under the care of Broca. He could only speak the word "tan." The word was repeated usually twice in quick succession, regardless of the question asked. This was combined with expressive gestures of various kinds. It is not known if these symptoms were acute in onset or had gradually progressed and if any other symptoms were associated with them. ⁴ He communicated all of his needs by way of gestures and understood spoken language well. It is believed that Leborgne grew up in a place where there were many tanneries, and this may have an influence on his using the verbal stereotype "tan." On some occasions when he was enraged, he could produce a single swear word or a short phrase. He was best in numerical responses, which he showed by using his fingers. He could show, by way of gestures, the exact time of the day and number of years he had spent in hospital. His intellect was normal. There were no signs of physical trauma. ³ "Tan" was regarded as "egotistical, vindictive, bad and some of his comrades even had accused him of being a thief." ⁴

After 10 years of onset of his first symptom, he began developing new symptoms. He developed gradual weakness of his right arm. This progressed to complete paralysis and was followed by weakness of his right lower limb. Initially, he could walk by dragging his right foot. Eventually he became confined to bed. Broca noted that it took 4 years from the start of the paralysis of the right arm to the point when the patient could not stand by himself anymore. ⁴ His comrades no longer occupied themselves with him. There was a deterioration in his mental faculties. He was having problems with his vision. He became bed bound and refused to leave the bed. He continued to remain in that state for the last 7 years of his life.1, 5, 6 In April 1861, Leborgne developed swelling of his right lower limb followed by gangrene and infection. His clothes were changed once a week, and consequently the phlegmon was recognized by the nurses only when it had spread extensively up to the buttocks. ⁴ It was described as a "diffuse, gangrenous phlegmon of the entire right inferior limb, from the instep up to the buttock." ⁴ His condition had deteriorated significantly, and he could hardly move. As a result, he was transferred to the surgical ward on 11 April 1861.

By a stroke of fate, the 50-year-old Leborgne was transferred under the care of a surgeon: Broca, who made a detailed examination of the patient. He interrogated his minders, fellows on the ward, and his parents about the past medical illness. Broca observed that there was complete paralysis of the patient's right-side limbs. Leborgne could move his left limbs at will and with adequate power. ⁴ His bowel and bladder control was intact. He did not have strabismus, and tongue was not paralyzed. ⁴ He had difficulty in swallowing food. The voice was normal. Broca presented him his watch, which had a missing second's hand. Leborgne could relate the exact time. His left eye vision had deteriorated more than the right eye. Leborgne could neither speak nor write due to the paralysis of his right side. He could convey an astounding amount of information to Broca by using gestures from his left hand and facial expression. Leborgne made occasional inappropriate answers like claiming that he had children when he had none. This was attributed to the effects of sepsis. Broca termed the condition "aphemie" or loss of articulated speech. ⁶ In his words, "This abolition of speech, in individuals who are neither paralyzed nor idiots, constitutes a symptom so singular that it seems to me useful to designate it with a special name. I will give it, therefore, the name of aphemia." ⁴

On 17 April 1861, Leborgne passed away at 11 o'clock in the morning. Twenty-four hours later an autopsy was carried out by Broca, who described a softened area centered over the perisylvian region. He noted a cavity filled with serous fluid in the left perisylvian region the size of a "chicken's egg." There was volume loss affecting the inferior 2 frontal gyri posteriorly, parts of superior temporal gyrus, subcortical perisylvian area, insula, and part of the striate nucleus. Broca also weighed the brain and found that it was lighter than the normal weight of the brain. He attributed it to the volume loss in the left cerebral hemisphere around the sylvian fissure. From the autopsy findings described by Broca, it appears that Leborgne might have suffered an ischemic insult affecting the left perisylvian region. No description of a mass has been suggested. The neurologic deterioration that occurred in the later part of Leborgne's life could have been a subsequent vascular insult leading to hemiparesis and a bed-bound state.

In the mid-19th century, Paris was in the midst of a scientific literary expansion. Scientific discoveries were keenly followed by news reporters, and literary awareness was in full swing. Ideas relating to the physiology of organ function and disease causation were readily circulated throughout Europe. It was during such time that Broca started his work. He completed his graduation from the medical school in Paris in 1844 and successfully rose to become the professor of surgery. Broca was an astute physician. His interests stretched from histology to anthropology. His works ranged from treatment of aneurysms, cancer treatment, histology of cartilage, to the anatomy of the limbic system. ⁷ He had a keen interest in evolution. Broca was fortunate to live in a time when it was easy for clinicians to carry out autopsy studies and complement their findings with laboratory work. He made over 500 scientific publications and actively participated in scientific discussions (Figure 2).

The Anthropology Society of Paris was a platform where new ideas about the functioning of brain and its evolution were discussed and fiercely debated. It is important to note that the knowledge about the functioning of the human brain, which is so easily available today from books and medical school, was in fact possible through an intense reasoning by some of the greatest minds of that time. These meetings, held on the first and third Thursdays of each month, were a platform where many significant ideas about the functioning of human brain were born. ⁵ Bouillard made the first assertions after clinicopathologic studies that motor functions are controlled by the contralateral hemisphere. ² Louis Pierre Gratiolet, a senior anatomist, was an ardent believer that the brain functions as a whole and discrete areas do not have individual functions (Flourens's theory of unified function of the brain). Ernest Auburtin, a physician and son-in-law of Bouillard, opposed the ideology of Gratiolet and believed that specific areas of the brain had specific functions. In particular, Auburtin was interested in cases of loss of speech. Perhaps Auburtin's theories about specific areas in the brain holding specialized functions is what made Broca first postulate the concept of aphasia.

Broca opened the 40th meeting of the Anthropology Society of Paris on 18 April 1861 and credited his teacher, Bouillard, with localizing the language function to the frontal lobes. It was at this occasion of scientific argument that the case of Leborgne was presented to the society by Broca. The stage was set, and a battle was drawn between the supporters of localization and those that supported universality in the functioning of the brain. Auburtin had continued his father-in-law's work and described how cases of stroke that involved the anterior lobes produced different clinical features than those involving the middle lobes. ⁵ Broca proceeded to give an account of Leborgne's medical history and presented the preserved brain of Leborgne to the society. After describing the lesion in the frontal lobe, Broca concluded that the lesion in the frontal lobe was responsible for the patient's speech disturbance. This presentation was followed by Gratiolet, who strongly voiced in favor of the unified functioning of the brain and existence of the soul. He opposed the idea that there could exist a specific center responsible for speech. ⁵ The proceedings were concluded by Auburtin, who stated that the faculty of speech existing in the frontal lobes was responsible for motor articulation and had no direct relevance to the ability of conceptualization of ideas and words.

In the next meeting, Broca reminded the society again about the case of Leborgne. It must be recalled that Broca had a chance encounter with the case of Leborgne and was not actively pursuing the issues relating to language function. However, after presenting this case to the society, he began to realize the importance of his finding. A few months after the death of Leborgne, Broca had come across another patient, Lelong, with speech disturbance similar to that of Leborgne. Lelong could speak up to 5 words. After his death, Broca autopsied his brain and found a lesion similar to one he had reported in Leborgne's brain. By August 1861, he had collected several cases with similar speech disturbance and coined the term "aphemie." Trousseau later suggested the term "aphasie" instead of "aphemie," which gained popularity in the scientific literature. ⁵ Broca had remarkable insights into the cortical functioning of speech. He had initially believed that speech disturbance occurs with injuries to either hemispheres and then localized the speech disturbance in many of the cases to the left frontal lobe. Broca also realized that speech disturbance could arise due to injury to the right hemisphere in some cases, a condition now called crossed aphasia. In one of his scientific papers, he also suggested the role of speech therapy in rehabilitating these patients.

The brain of Leborgne is currently housed at the Musee Dupuytren museum in Paris, France. Broca examined Leborgne's brain without dissecting it and chose to preserve the brain. He wrote that the lesion affected "the small convolutions of the insula and the corpus striatum ... As to the deep parts ... I could half-way examine the inner surface of the anterior horn of the lateral ventricle ...." ⁸ It appears from his writings that he was aware that the lesion had involved more medial structures than were apparent on the surface. Leborgne's brain has been imaged on 3 occasions in the past. The first imaging was a computed tomography scan, which was done in 1980 by Castaigne et al. ⁸ It was scanned with magnetic resonance imaging (MRI) in 1994 by Cabanis et al ⁹ and once again by high-resolution MRI with volumetric assay in 2007 by Dronkers et al. ⁸ Recent examinations of Leborgne's brain have shown that the maximum damage is at middle one third of the inferior frontal gyrus and not at the posterior part of the inferior frontal gyrus, which shows only atrophy. Gross inspection reveals that the most striking area of damage is seen in the middle third of the inferior frontal gyrus. There is atrophy of the middle frontal gyrus, anterior superior temporal gyrus, and anteroinferior parietal lobe as well. Dronkers et al ⁸ found extensive damage in the left cerebral hemisphere of Leborgne's brain with high-resolution MRI. The structures that were damaged included the claustrum, putamen, globus pallidus, head of the caudate nucleus, external capsule, internal capsules, insula, frontoparietal and periventricular white matter. It is of interest to note that there was complete destruction of the arcuate fasciculus. The left hemisphere, when measured from the midline to the lateral surface, was 50% smaller than the right hemisphere. ⁸ Extensive damage involving the subcortical structures in Leborgne's brain is not limited to the inferior frontal gyrus.

The Wernicke-Lichtheim model denoting the left inferior frontal region as the motor area and posterior temporal region as the receptive area has been taught well over a century. It has gradually been replaced by a more modern understanding of human speech due to the developments in the field of noninvasive functional brain imaging. ¹⁰ Broca aphasia does not necessarily implicate isolated injury to the Broca area. The language function has now been attributed to distributed global networks in both hemispheres. Even the Broca area has been shown to have several subdivisions with specific functions. ¹⁰ The role of the middle temporal gyrus, anterior temporal lobe, and also the nondominant hemisphere in speech production has now been recognized. ¹¹ Motor speech is an orchestra of coordination of several areas in the brain and our understanding of which is still incomplete. The memories of words are collected from temporal lobes and converted to articulatory movements in the motor cortex. The Broca area monitors this information and conducts reciprocal interactions between frontal and temporal lobes with the help of the arcuate fasciculus.12, 13 It coordinates the transformation of information from several large neuronal networks toward the motor cortex. ¹³ Broca aphasia or nonfluent aphasia is an umbrella term that includes many disorders of speech production. The broad categorization into fluent and nonfluent aphasia may not encompass many disorders that have common findings. The isolated damage or infarction of the Broca area produces a mutism, which changes to a dyspraxic and effortful articulation and resolves completely in most cases. ¹² The classical Broca aphasia seen in the case of Leborgne with prolonged mutism, verbal stereotypes, and agrammatism involves not just the Broca area but also larger regions of the brain like the insula, operculum, and arcuate fasciculus in the distribution of the middle cerebral artery. ¹² The Broca area has been found to be surprisingly quiescent during articulation when direct cortical recordings are made while speaking. ¹³ It is now thought that the Broca area coordinates processing of information from large neuronal networks to the motor cortex before articulation. ¹³

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Louis Victor Leborgne was a patient of Paul Broca. "Monsieur Leborgne," as Broca would call him, was also known around in the hospital by the nickname...

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Imagen representativa del cerebro de "Tan"

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Primeros avances de la Neuropsicología Moderna.

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UBICACIÓN DE FUNCIÓN DENTRO DEL CEREBRO HUMANO 

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UBICACIÓN DE FUNCIÓN DENTRO DEL CEREBRO HUMANO 

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Historia de la Neuropsicología Segunda Parte. Paul Broca

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El área de Broca: localización y función.