WBR0577

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Anatomy, MainCategory::Pathophysiology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 72-year-old male patient with history of atrial fibrillation on warfarin was admitted to the hospital for progressively increasing headaches since 10 days and recent weird speech. The patient's wife informs the physician that the patient complained about a headache that started insidiously almost 10 days ago and has been progressively getting worse. The wife reports a history of mild trauma three weeks ago, during which the patient tripped and fell on his head. Upon questioning the patient, he answers back fluently and says: "A plane drink and I can not shower for coffee feet the trash". CT scan reveals subdural hematoma. Which of the following is the most likely area of the brain responsible for the patient's speech dysfunction?]]
Answer A	AnswerA::Superior temporal gyrus
Answer A Explanation	[[AnswerAExp::Wernicke's aphasia is a speech dysfunction characterized by impaired comprehension, intact speech fluency and impaired repetition. It results from damage to the superior temporal gyrus. Wernicke's aphasia is also known as sensory or receptive aphasia.]]
Answer B	AnswerB::Inferior frontal gyrus
Answer B Explanation	[[AnswerBExp::Broca's aphasia is a speech dysfunction characterized by intact comprehension, impaired speech fluency and impaired repetition. It results from damage to the inferior frontal gyrus. Broca's aphasia is also known as motor or expressive aphasia.]]
Answer C	AnswerC::Superior temporal and frontal gyri
Answer C Explanation	[[AnswerCExp::Global aphasia is a speech dysfunction characterized by impaired comprehension, impaired speech fluency and impaired repetition. It results from damage to a larger area of the brain involving the superior temporal and inferior frontal gyri.]]
Answer D	AnswerD::Arcuate fasiculus
Answer D Explanation	[[AnswerDExp::Conduction aphasia is a speech dysfunction characterized by intact comprehension, intact speech fluency and impaired repetition. It results from damage to the arcuate fasciculus.]]
Answer E	AnswerE::Between the supplementary motor area and the frontal perisylvian speech zone
Answer E Explanation	[[AnswerEExp::Transcortical motor aphasia is a speech dysfunction characterized by impaired comprehension, impaired speech fluency and intact repetition. It results from damage to the area between the supplementary motor area and the frontal perisylvian speech zone.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::The patient's presentation of progressively worsening headache and sensory aphasia following a history of trauma three weeks ago is suggestive of chronic subdural hemorrhage. The patient's age, use of anticoagulants and history of mild trauma support the diagnosis. The diagnosis is confirmed by the findings on CT scan. The patient's speech dysfunction is manifested by intact fluency and impaired comprehension which is characteristic of Wernicke's aphasia. Wernicke's aphasia is also known as sensory or receptive aphasia. There are several types of aphasia: Wernicke's aphasia: impaired comprehension, intact speech fluency and impaired repetition. Broca's aphasia: intact comprehension, impaired speech fluency and impaired repetition. Global aphasia: impaired comprehension, impaired speech fluency and impaired repetition. Conduction aphasia: intact comprehension, intact speech fluency and impaired repetition. Shown below is an image depicting the different areas involved in the different types of aphasia. Educational Objective: Wernicke's aphasia is a speech dysfunction characterized by impaired comprehension, intact speech fluency and impaired repetition. It results from damage to the superior temporal gyrus. Wernicke's aphasia is also known as sensory or receptive aphasia. References: First Aid 2014 page 457]]
Approved	Approved::No
Keyword	WBRKeyword::Aphasia, WBRKeyword::Wernicke aphasia, WBRKeyword::Frontal lobe, WBRKeyword::Subdural hematoma
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::