Queston #6713Note

This patient is experiencing transcortical motor aphasia (TMoA), which is similar to Broca’s aphasia except repetition is intact. TMoA is caused by an infarct in the anterior superior frontal lobe (prefrontal cortex) in the perisylvian area of the language-dominant (typically the left) hemisphere. This area is damaged when the ACA is occluded. The major language networks (Broca’s, Wernicke’s, and the arcuate fasciculus) are therefore unaffected. This patient likely has an ACA infarct on the left, probably from cardioembolism from atrial fibrillation, and therefore would also be expected to have right leg weakness. Right face and arm strength are controlled by MCA territory structures, and homonymous hemianopsia is caused by damage in MCA- or PCA-supplied structures. Alalculia and finger agnosia are components of Gerstmann syndrome, which is caused by an infarct in the temporal-parietal junction. Extinction is caused by a non-dominant (usually right) parietal lobe infarct.