A highly agitated 54-year-old man is brought to the emergency department by his family because he is unable to effectively communicate. He speaks clearly and with conviction but his sentences are incomprehensible. He does not appear to understand the doctor's questions, does not follow oral or written instructions, and cannot repeat simple phrases. Branch occlusion of which of the following arteries is most likely responsible for this patient's condition?

Question

A highly agitated 54-year-old man is brought to the emergency department by his family because he is unable to effectively communicate.  He speaks clearly and with conviction but his sentences are incomprehensible.  He does not appear to understand the doctor's questions, does not follow oral or written instructions, and cannot repeat simple phrases.  Branch occlusion of which of the following arteries is most likely responsible for this patient's condition?

Quizplus · Accepted Answer

This patient has fluent aphasia, a form of receptive aphasia characterized by speech that is fluent, well articulated, and melodic - but meaningless. Individuals stricken with fluent aphasia cannot understand verbal or written language. Repetition is usually affected to the same degree as the impairment in comprehension. Typically, patients will have no awareness of their cognitive deficit. Fluent aphasia is often produced by a lesion in Wernicke's area, which is located in the auditory association cortex within the posterior portion of the superior temporal gyrus in the dominant (usually left) temporal lobe. The regions of the cerebral cortex supplied by the middle cerebral artery (MCA) are approximated by the red oval in the image below. The inferior terminal MCA branches supply Wernicke's area. 11ec160b_3594_fab1_9249_a73f53175991_MD0001_00 (Choices A, B, D, and E) The anterior cerebral artery, anterior inferior cerebellar artery, posterior cerebral artery, and posterior inferior cerebellar artery do not typically service Wernicke's area. Consequently, occlusions of these arteries would not be associated with Wernicke's aphasia. Educational objective: A lesion in Wernicke's area can cause receptive aphasia, which is characterized by well-articulated, nonsensical speech paired with a lack of language comprehension (Wernicke-Word salad). Wernicke's area is located in the auditory association cortex within the posterior portion of the superior temporal gyrus in the dominant temporal lobe. The middle cerebral artery supplies Broca's area (superior division) and Wernicke's area (inferior division).

A Highly Agitated 54-Year-Old Man Is Brought to the Emergency