Aphasia - Neurology - Medbullets Step 1

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
ComprehensionRepetition
Broca (expressive)A lesion affecting
Broca area (inferior frontal lobe)often secondary to an infarct involving thesuperior 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 theinferior division of the left MCA
Yes
No
No
ConductionA lesion affecting thearcuate fasciculuscan be secondary to any lesion involving theperi-Sylvian area
Yes
Yes
No
GlobalCan be secondary toa proximal MCA occlusion affecting bothsuperior and inferior division of the MCA
a large superior division infarct that later becomes a
Broca's aphasia
large subcortical lesions such ashemorrhages
infarcts
No
No
No
Transcortical motorCan be secondary toan anterior cerebral artery (ACA)-MCA watershed infarct
No
Yes
Yes
Transcortical sensory
Can be secondary toa posterior cerebral artery (PCA)-MCA watershed infarct
Yes
No
Yes
Transcortical mixedCan be secondary toboth an ACA-MCA and PCA-MCA infarct
No
No
Yes

                        Aphasia Syndromes
Aphasia
Lesion
Fluency
ComprehensionRepetition
Broca (expressive)A lesion affecting
Broca area (inferior frontal lobe)often secondary to an infarct involving thesuperior 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 theinferior division of the left MCA
Yes
No
No
ConductionA lesion affecting thearcuate fasciculuscan be secondary to any lesion involving theperi-Sylvian area
Yes
Yes
No
GlobalCan be secondary toa proximal MCA occlusion affecting bothsuperior and inferior division of the MCA
a large superior division infarct that later becomes a
Broca's aphasia
large subcortical lesions such ashemorrhages
infarcts
No
No
No
Transcortical motorCan be secondary toan anterior cerebral artery (ACA)-MCA watershed infarct
No
Yes
Yes
Transcortical sensory
Can be secondary toa posterior cerebral artery (PCA)-MCA watershed infarct
Yes
No
Yes
Transcortical mixedCan be secondary toboth an ACA-MCA and PCA-MCA infarct
No
No
Yes

Action	Numeric Key	Letter Key	Function Key
Show Bullets		S	Enter (frontside only)
20%	1	N
40%	2	H
60%	3	F	Enter (backside only)
80%	4	E
100%	5	M
Toss	0	T

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