A patient has left homonymous hemianopsia, visual agnosia, and receptive aprosody. Which stroke is most likely?

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Multiple Choice

A patient has left homonymous hemianopsia, visual agnosia, and receptive aprosody. Which stroke is most likely?

The pattern of deficits points to damage in the right posterior cerebral territory, affecting the occipital and ventral-temporal regions and the right hemisphere’s prosody processing. Left homonymous hemianopsia occurs when the right occipital cortex or its optic radiations are disrupted, producing a loss of the left visual field in both eyes. Visual agnosia arises from impairment of the ventral stream in the occipitotemporal region, which on the right side more prominently affects nonverbal object recognition. Receptive aprosody reflects deficit in understanding intonation and emotional tone, a function strongly lateralized to the right hemisphere, involving temporal-parietal areas. A stroke in the right PCA would encompass these areas, producing this combination of symptoms. If the stroke were on the left PCA, you’d expect right visual field loss instead of left. A right MCA stroke would more typically cause neglect or other lateralized cognitive-spatial deficits rather than the specific triad here. A basilar artery stroke would present with brainstem signs, not this focal posterior pattern.

The pattern of deficits points to damage in the right posterior cerebral territory, affecting the occipital and ventral-temporal regions and the right hemisphere’s prosody processing. Left homonymous hemianopsia occurs when the right occipital cortex or its optic radiations are disrupted, producing a loss of the left visual field in both eyes. Visual agnosia arises from impairment of the ventral stream in the occipitotemporal region, which on the right side more prominently affects nonverbal object recognition. Receptive aprosody reflects deficit in understanding intonation and emotional tone, a function strongly lateralized to the right hemisphere, involving temporal-parietal areas. A stroke in the right PCA would encompass these areas, producing this combination of symptoms.

If the stroke were on the left PCA, you’d expect right visual field loss instead of left. A right MCA stroke would more typically cause neglect or other lateralized cognitive-spatial deficits rather than the specific triad here. A basilar artery stroke would present with brainstem signs, not this focal posterior pattern.

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