Right face and arm motor loss (sometimes sensory loss) with Broca's or transcortical motor aphasia. Which stroke territory?

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Multiple Choice

Right face and arm motor loss (sometimes sensory loss) with Broca's or transcortical motor aphasia. Which stroke territory?

The test concept is that language-dominant hemisphere strokes affecting the frontal language area also involve nearby motor cortex, so you get aphasia plus contralateral face and arm weakness. In most people, language is in the left hemisphere, and Broca’s area sits in the dominant left frontal lobe. The superior division of the left MCA supplies Broca’s area and the adjacent lateral motor cortex for the face and arm. When this territory is occluded, you see a nonfluent aphasia (Broca’s) or related transcortical motor aphasia with weakness on the right side of the face and arm, and sometimes mild sensory loss. If it were a left ACA stroke, the weakness would be more leg-dominant with little aphasia. A left MCA inferior division stroke would more likely produce a fluent aphasia (Wernicke’s) with a different sensory/motor pattern. A right MCA stroke would cause left-sided neglect and motor deficits without language disturbance in a right-handed person.

The test concept is that language-dominant hemisphere strokes affecting the frontal language area also involve nearby motor cortex, so you get aphasia plus contralateral face and arm weakness. In most people, language is in the left hemisphere, and Broca’s area sits in the dominant left frontal lobe. The superior division of the left MCA supplies Broca’s area and the adjacent lateral motor cortex for the face and arm. When this territory is occluded, you see a nonfluent aphasia (Broca’s) or related transcortical motor aphasia with weakness on the right side of the face and arm, and sometimes mild sensory loss.

If it were a left ACA stroke, the weakness would be more leg-dominant with little aphasia. A left MCA inferior division stroke would more likely produce a fluent aphasia (Wernicke’s) with a different sensory/motor pattern. A right MCA stroke would cause left-sided neglect and motor deficits without language disturbance in a right-handed person.

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