Stroke: The Daily PANCE Blueprint
A 68-year-old man is brought to the emergency department by his family due to sudden difficulty with speech and comprehension. He speaks fluently, but his sentences are nonsensical and he appears frustrated. He does not understand simple commands, cannot repeat phrases, and struggles to find the right words. Which branch occlusion of the following arteries is most likely responsible for this patient's condition?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Middle cerebral artery
D. Basilar artery
E. Vertebral artery
Answer and topic summary
The answer is C. Middle cerebral artery
The middle cerebral artery (MCA) supplies blood to the lateral surfaces of the frontal, temporal, and parietal lobes. Occlusion of the MCA, especially in the dominant hemisphere (usually the left), can lead to Wernicke’s aphasia, characterized by fluent but nonsensical speech, poor comprehension, and an inability to follow commands or repeat phrases. This patient’s symptoms are indicative of Wernicke’s aphasia.
Incorrect Answers:
- A. Anterior cerebral artery – Occlusion here typically affects the medial frontal and parietal lobes, leading to contralateral leg weakness and personality changes, but not fluent aphasia.
- B. Posterior cerebral artery – Occlusion here affects the occipital lobe, leading to visual field deficits such as homonymous hemianopia, but not aphasia.
- D. Basilar artery – Occlusion here can lead to brainstem symptoms, such as cranial nerve palsies and locked-in syndrome, but not fluent aphasia.
- E. Vertebral artery – Occlusion typically affects the brainstem and cerebellum, leading to dizziness, ataxia, and cranial nerve deficits, but not fluent aphasia.
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