A stroke in which territory is most likely to cause aphasia and right hemiparesis in a right-handed patient?

A stroke in which territory is most likely to cause aphasia and right hemiparesis in a right-handed patient?

• A. Left anterior cerebral artery
• B. Right middle cerebral artery
• C. Left middle cerebral artery
• D. Left posterior cerebral artery

Answer: (C)

Aphasia plus contralateral (right) hemiparesis in a right-handed person most strongly points to a stroke in the language-dominant hemisphere, which is typically the left side. The left middle cerebral artery supplies the lateral frontal and temporal lobes where the language areas (Broca’s and Wernicke’s regions) reside, and it also carries fibers for movement of the face and arm. When this territory is affected, you get disruption of language and weakness of the face and arm on the opposite side, hence aphasia with right hemiparesis. Other territories don’t fit as well. An anterior cerebral artery stroke mainly causes leg weakness and frontal-disinhibition symptoms rather than aphasia. A right middle cerebral artery stroke would produce left-sided neglect and left-sided weakness but not aphasia in a right-handed person. A left posterior cerebral artery stroke commonly affects vision and memory with less emphasis on motor weakness and aphasia.

Aphasia plus contralateral (right) hemiparesis in a right-handed person most strongly points to a stroke in the language-dominant hemisphere, which is typically the left side. The left middle cerebral artery supplies the lateral frontal and temporal lobes where the language areas (Broca’s and Wernicke’s regions) reside, and it also carries fibers for movement of the face and arm. When this territory is affected, you get disruption of language and weakness of the face and arm on the opposite side, hence aphasia with right hemiparesis.

Other territories don’t fit as well. An anterior cerebral artery stroke mainly causes leg weakness and frontal-disinhibition symptoms rather than aphasia. A right middle cerebral artery stroke would produce left-sided neglect and left-sided weakness but not aphasia in a right-handed person. A left posterior cerebral artery stroke commonly affects vision and memory with less emphasis on motor weakness and aphasia.