Overview Snapshot A 65-year-old woman presents to the emergency department with meaningless speech. The patient was in her usual state of health until 3 hours prior to presentation, where her daughter noticed her mother having "strange speech." On physical examination, her speech is fluent, has paraphasic errors, and comprehension and repetition is impaired. On visual field testing there is a right upper quadrant field-cut. (Wernicke aphasia) Introduction Aphasia Syndromes Aphasia Lesion Fluency Comprehension Repetition Broca (expressive) A lesion affecting Broca area (inferior frontal lobe) often secondary to an infarct involving the superior division of the left middle cerebral artery (MCA) No Yes No Wernicke (receptive) A lesion affecting Wernicke area (superior temporal lobe) often secondary to an infarct involving the inferior division of the left MCA Yes No No Conduction A lesion affecting the arcuate fasciculus can be secondary to any lesion involving the peri-Sylvian area Yes Yes No Global Can be secondary to a proximal MCA occlusion affecting both superior and inferior division of the MCA a large superior division infarct that later becomes a Broca's aphasia large subcortical lesions such as hemorrhages infarcts No No No Transcortical motor Can be secondary to an anterior cerebral artery (ACA)-MCA watershed infarct No Yes Yes Transcortical sensory Can be secondary to a posterior cerebral artery (PCA)-MCA watershed infarct Yes No Yes Transcortical mixed Can be secondary to both an ACA-MCA and PCA-MCA infarct No No Yes