A 70-year-old patient presents to the emergency department following a stroke. Post-stroke, the patient exhibits fluent speech that is riddled with paraphasic errors—substituting incorrect words within sentences. Additionally, there is a marked difficulty in understanding spoken language, and the patient is unable to repeat even simple phrases. These clinical features are indicative of Wernicke’s aphasia, a condition resulting from damage to the posterior portion of the left superior temporal gyrus, commonly known as Wernicke’s area. Which of the following is a common additional neurological deficit associated with Wernicke’s aphasia?

A 68-year-old man with a history of hypertension and atrial fibrillation is brought to the emergency department by his wife. She reports that he suddenly began speaking in long, fluent sentences that made no sense. For example, he said, “The banana is flying over the moon with the green sky,” which confused her. He seems unaware that his speech is abnormal and becomes frustrated when she does not understand him. He also has difficulty following her commands, such as “pick up the cup” or “close the door.” On examination, the patient is alert and cooperative. His speech is fluent but contains neologisms (made-up words) and paraphasic errors (substituting incorrect words). He is unable to repeat simple phrases or follow verbal commands. Neurological examination reveals no motor deficits, and his vision and hearing appear intact. An MRI of the brain is ordered, which reveals an infarct in the left temporal lobe. Which artery is most likely implicated in this patient’s condition?

A 62-year-old right-handed man is brought to the emergency department by his family after they noticed a sudden change in his ability to communicate. Earlier in the day, he was speaking normally, but he suddenly began speaking in long, fluent sentences that made little sense. For example, he said, “The table is running in the park with the sky,” which confused his family. He seems unaware that his speech is abnormal and becomes frustrated when others do not understand him. He also has difficulty understanding what others are saying to him, often responding inappropriately to questions or commands. On examination, the patient is alert and cooperative. His speech is fluent but contains paraphasic errors (substituting incorrect words or using nonsensical phrases). He is unable to repeat simple phrases or follow verbal commands, such as “raise your left hand.” Neurological examination reveals no motor deficits, and his vision and hearing appear intact. An MRI of the brain is ordered. Which area of the brain is most likely affected in this patient?

A 70-year-old man is brought to the emergency department after suddenly experiencing difficulty understanding speech. His wife reports that, although he speaks fluently, he often uses incorrect words, making his sentences nonsensical. For example, he might say “book” when referring to a “phone.” During the examination, he is unable to repeat simple phrases or follow commands, indicating significant comprehension deficits. An MRI reveals a lesion in the left temporal lobe, specifically affecting Wernicke’s area. Which of the following is the most likely mechanism of injury in this patient?

A 65-year-old man is brought to the neurology clinic by his family, who are concerned about his recent language difficulties. Two weeks ago, he experienced an ischemic stroke affecting the left posterior superior temporal gyrus. Since the stroke, his family has observed that while he speaks fluently, his sentences often contain incorrect words or nonsensical phrases. For instance, he might say “television” when referring to a “refrigerator.” He also appears to have trouble understanding conversations and following simple instructions. During the clinical examination, his speech is fluent but marked by paraphasic errors, such as saying “table” instead of “chair.” He is unable to repeat simple phrases and struggles to follow commands, indicating a significant comprehension deficit. Which of the following is the most likely diagnosis?