Transcortical motor aphasia with right motor and sensory impairment for trunk, hips, proximal extremities. Which stroke territory?

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Multiple Choice

Transcortical motor aphasia with right motor and sensory impairment for trunk, hips, proximal extremities. Which stroke territory?

Transcortical motor aphasia arises when a dominant-hemisphere lesion disrupts the connection between language production areas (like Broca’s area) and motor planning regions (the supplementary motor area) at the border between the ACA and MCA. This pattern produces nonfluent speech with relatively preserved comprehension and preserved repetition. The accompanying right-sided weakness of the trunk, hips, and proximal extremities points to involvement of the medial motor cortex supplied by the anterior cerebral artery. Taken together, these findings localize to the left ACA-MCA watershed territory in a typically left-dominant brain, which explains both the language deficit and the proximal-limb weakness on the right. The other territories don’t fit as well. A right ACA-MCA stroke would cause left-sided (not right) weakness. A left MCA-PCA stroke would involve different cortical areas and isn’t the classic pattern for transcortical motor aphasia. A left MCA superior stroke would more likely produce Broca’s aphasia with arm/face weakness, not the transcortical motor aphasia profile with preserved repetition.

Transcortical motor aphasia arises when a dominant-hemisphere lesion disrupts the connection between language production areas (like Broca’s area) and motor planning regions (the supplementary motor area) at the border between the ACA and MCA. This pattern produces nonfluent speech with relatively preserved comprehension and preserved repetition. The accompanying right-sided weakness of the trunk, hips, and proximal extremities points to involvement of the medial motor cortex supplied by the anterior cerebral artery. Taken together, these findings localize to the left ACA-MCA watershed territory in a typically left-dominant brain, which explains both the language deficit and the proximal-limb weakness on the right.

The other territories don’t fit as well. A right ACA-MCA stroke would cause left-sided (not right) weakness. A left MCA-PCA stroke would involve different cortical areas and isn’t the classic pattern for transcortical motor aphasia. A left MCA superior stroke would more likely produce Broca’s aphasia with arm/face weakness, not the transcortical motor aphasia profile with preserved repetition.

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