A 68-year-old right-handed hypertensive man suddenly becomes unable to produce speech. He understands commands well, appears frustrated by his errors, and repeats phrases poorly. Examination shows right lower facial droop and weakness of the right arm, with the right leg largely spared. Which vessel is most likely occluded?

• A Left anterior cerebral artery
• B Inferior division of the left middle cerebral artery
• C Superior division of the left middle cerebral artery ✓
• D Left posterior cerebral artery

Explanation

Broca aphasia with right face and arm predominance localises to the inferior frontal gyrus and adjacent motor cortex, territory of the superior division of the left MCA. The inferior division supplies Wernicke area, giving fluent aphasia with poor comprehension instead. The ACA causes leg-predominant weakness and does not explain aphasia, while the PCA territory includes the visual cortex and splenium, producing hemianopia or alexia rather than nonfluent aphasia.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.