A 54-year-old man is brought to the emergency department by his wife after he develops difficulty speaking. When asked about the onset of his symptoms, the patient slowly responds with "I... weak... morning..." and becomes very frustrated. His wife says that he was able to grasp a pen without any problem while completing medical release forms, but had trouble signing his name. On examination, he is able to state his first name but with difficulty, and correctly points to different body parts on command. He also has mild weakness involving his right arm and face. This patient's speech difficulties are most likely caused by a lesion affecting which of the following brain areas?

Question

A 54-year-old man is brought to the emergency department by his wife after he develops difficulty speaking.  When asked about the onset of his symptoms, the patient slowly responds with "I... weak... morning..." and becomes very frustrated.  His wife says that he was able to grasp a pen without any problem while completing medical release forms, but had trouble signing his name.  On examination, he is able to state his first name but with difficulty, and correctly points to different body parts on command.  He also has mild weakness involving his right arm and face.  This patient's speech difficulties are most likely caused by a lesion affecting which of the following brain areas?

Quizplus · Accepted Answer

11ec160b_3595_96f3_9249_d7d0c5b1f7d9_MD0001_00 This patient most likely has Broca (motor, nonfluent) aphasia. This condition classically results from damage to Broca area of the brain, the region responsible for all communicative motor planning. Individuals are able to communicate meaningfully, but their speech is slow and consists primarily of nouns and verbs. Speech may be punctuated by pauses after each word as the patient attempts to verbalize the next. Patients also often have difficulty writing and signing, and become frustrated as they have insight into their expressive language difficulties. They can understand spoken language and follow commands (intact speech comprehension) as Wernicke area is unaffected. Broca area is in the caudal part of the inferior frontal gyrus of the dominant (usually left) hemisphere (Brodmann areas 44 and 45). Patients may have associated right hemiparesis involving the upper limb and face due to this region's proximity to the primary motor cortex. (Choice A) The frontal eye field is found near the caudal end of the middle frontal gyrus anterior to the precentral sulcus (Brodmann areas 6 and 8). Damage here would cause the eyes to deviate to the ipsilateral side. (Choice C) Lesions to the precentral gyrus (primary motor cortex) can cause slurred speech (dysarthria) due to paresis/paralysis of the skeletal muscles involved in movements of the mouth, tongue, and larynx. Damage to Broca area is often associated with right-sided hemiparesis and oral apraxia due to extension of the lesion into the ipsilateral motor regions. However, it is injury to Broca area that leads to language deficit. (Choice D) This is the postcentral gyrus (primary somatosensory cortex). A lesion here would cause sensation loss in the corresponding area of the contralateral body. (Choice E) The caudal superior temporal gyrus (Brodmann area 22) is in the Wernicke area. A lesion here would cause a sensory (receptive) aphasia. Wernicke aphasia is also known as fluent aphasia in that speech flows readily but is meaningless ("word salad"). Patients typically lack insight into their problem. (Choice F) A lesion to the visual cortex can cause cortical blindness or visual impairment that can make reading and writing difficult. Spoken speech would be unaffected. Educational objective: Broca (motor, nonfluent) aphasia results from damage to the inferior frontal gyrus of the dominant hemisphere. Patients are often frustrated as they understand language but cannot properly formulate the motor commands to write or form words (eg, slow, fragmented speech). Aphasia may be associated with right upper limb and face weakness due to extension of the lesion into the primary motor cortex. __________ References: Neuroanatomic correlation of the post-stroke aphasias studied with imaging. (http://www.ncbi.nlm.nih.gov/pubmed/18544251)

A 54-Year-Old Man Is Brought to the Emergency Department by His