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This patient's fluent,
melodic spoken language with little meaningful content, combined
with an inability to comprehend spoken language, is characteristic
of Wernicke's
aphasia. The stroke, which affected the posterior part of the
superior temporal gyrus and neighboring cortex, has disrupted the
circuitry essential for comprehending sounds as being part of language.
These patients do not understand what is being said to them.
Additionally, they cannot correct errors in their own use of language,
which may be filled with sound-alike words, words used incorrectly
or made-up, meaningless words.
Part of the visual radiations representing the contralateral superior
quadrants loop forward into the temporal lobe, where they lie lateral
to the ventricle before turning and running posterior to the medial
occipital lobe. These fibers may therefore be at special risk from
an inferior branch occlusion. Detailed visual field testing in a
patient who cannot understand even simple directions is difficult. However,
where the patient does and doesn't see can be roughly determined
by whether or not s/he responds to threatening gestures in each
of the visual quadrants ('visual threat').
The normal eye movements and normal motor and somatosensory components
of the neurologic exam reinforce the idea that cortical regions
supplied by the superior branch of MCA are intact in this patient.
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