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?
