Fluent aphasia without weakness occurs due to which of the following culprit arteries?
Ans. c (Inferior division of MCA) (Ref: Harrison's Internal Medicine 18th/Ch. 26; 17th/pg.2524)If a fluent (Wernicke's) aphasia occurs without weakness, the inferior division of the MCA supplying the posterior part (temporal cortex) of the dominant hemisphere is probably involved. Jargon speech and an inability to comprehend written and spoken language are prominent features, often accompanied by a contralateral, homonymous superior quadrantanopia.# Partial syndromes due to embolic occlusion of a single branch include hand, or arm and hand, weakness alone (brachial syndrome) or facial weakness with nonfluent (Broca) aphasia, with or without arm weakness (frontal opercular syndrome).# A combination of sensory disturbance, motor weakness, and nonfluent aphasia suggests that an embolus has occluded the proximal superior division of MCA and infarcted large portions of the frontal and parietal cortices.# Hemineglect or spatial agnosia without weakness indicates that the inferior division of the MCA in the nondominant hemisphere is involved.Effect of strokesArteryArea of lesionSymptoms NotesNotesAnterior circulation MCAMotor cortex-upper limb and faceContralateral paralysis-upper limb and face Sensory cortex-upper limb and faceContralateral loss of sensation- upper and lower limbs, and face Temporal lobe (Wernicke are); frontal lobe (Broca area)Aphasia if in dominant (usually left) hemisphere. Hemineglect if lesion affects nondominant (usually right) side ACAMotor cortex-lower limbSensory cortex-lower limbContralateral paralysis-lower limbContralateral loss of sensation- lower limb Lenticulostriate arteryStriatum, internal capsuleContralateral hemiparesis/ hemiplegiaCommon location of lacunar infarcts, 2deg to unmanaged hypertensionPosterior circulationASALateral corticospinal tractMedial lemniscusCaudal medulla-hypoglossal nerveContralateral hemiparesis-upper and lower limbs| contralateral proprioception.Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)Stroke commonly bilateral.Medial medullary syndrome-caused by infact of paramedian branches of ASA and vertebral arteriesPICALateral medulla-vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguous, sympathetic fibres, inferior cerebellar peduncleVomiting, vertigo, nystagmus; | pain and temperature sensation from ipsilateral face and contralateral body; dysphagia, hoarseness. | gag reflex; ipsilateral Horner syndrome; ataxia, dysmetria.Lateral medullary (wallenberg) syndromeNucleus ambiguous effects are specific to PICA lesions. "Dont pick a (PICA) horse (hoarseness) that cant cat (dysphagia)"AICALateral pons-cranial nerve nuclei; vestibular nuclei; facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers.Middle and inferior cerebellar peduncles.Vomiting, vertigo, nystagmus.Paralysis of face, 4 lacrimation, salivation, 4 taste from anterior 2/3 of tongue, 4 corneal reflex. Face- 4 pain and temperature sensation.Ipsilateral 4 hearing. IpsilateralHorner syndrome.Ataxia, dysmetria.Lateral pontine syndrome.Facial nucleus effect are specific to AICA lesions."Facial droop means AlCA's pooped."PCAOccipital cotex, visual cortexContralateral hemianopia with macular sparing Basilar arteryPons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedian pontine reticular formationPreserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth and tongue movements."Locked- in syndrome"Communicating arteriesAComMost common lesion is aneurysm.Can lead to stroke. Saccular (berry) aneurysm can impinge cranial nerves.Visual fields defectsLesion are typically aneurysms, not strokes.PComCommon site of saccular aneurysm.CN III palsy - eye is "down and out" with ptosis and pupil dilation.Lesions are typically aneurysms, not strokes.APHASIA AND ASSOCIATED CULPRIT AREA AND ARTERY Aphasias and Related ConditionsComprehensionRepetition of Spoken languageNamingFluencyWernicke'sImpairedImpairedImpairedPreserved or increasedBroca'sPreserved (except grammar)ImpairedImpairedDecreasedGlobalImpairedImpairedImpairedDecreasedConductionPreservedImpairedImpairedPreservedNonfluent (motor) TranscorticalPreservedPreservedImpairedImpairedFluent (sensory) TranscorticalImpairedPreservedImpairedPreservedIsolationImpairedEcholaliaImpairedNo purposeful speechAnomicPreservedPreservedImpairedPreserved (word finding pauses+)Pure word deafnessImpaired for spoken languageImpairedPreservedPreservedPure alexiaimpaired only for readingPreservedPreservedPreservedEducational Points# Wernicke's aphasia not associated with weakness; can be associated with upper quadranto hemianaopia.# Broca's aphasia usually associated with hemiparesis.# Loss of contralateral conjugate gaze associated with fomtal lobe lesion.# Loss of Ipsilateral conjugate gaze associated with pontine lesion.# Most common type of aphasia is Anomic aphasia; due to angular gyrus involvement (Ganong).
Superior division of MCA (dominant lobe)
Hubner's branch of ACA
Inferior division of MCA
PCA (nondominant lobe)
C.N.S.