Broca aphasia — MRCPsych Paper A MCQ

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EasyNeuroanatomyBroca aphasiaMRCPsych Paper A

A 62-year-old right-handed man develops effortful, non-fluent, agrammatic speech after an acute ischaemic stroke. He accurately follows spoken one-step and two-step commands. Damage to which site best explains this presentation?

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Correct answer: D — Dominant posterior inferior frontal gyrus (Broca area)

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · C = shown as D · B = shown as E

C is correct. Effortful, non-fluent, agrammatic speech with relatively preserved auditory comprehension is the classical pattern of Broca aphasia, localised for examination purposes to the dominant posterior inferior frontal gyrus, particularly Brodmann areas 44 and 45. Contemporary models recognise that persistent Broca aphasia may involve a wider cortical and subcortical language network, but C is unequivocally the best option. Wernicke-area damage causes fluent, often paraphasic speech with impaired comprehension. A right inferior parietal lesion causes left-sided neglect. Bilateral hippocampal injury causes marked anterograde amnesia. A left fusiform lesion is more associated with impaired visual word or object processing than with non-fluent spoken language.

Reference: Le H, Lui F, Lui MY. Aphasia, classical aphasia model section. StatPearls, updated 29 October 2024 (2026 edition). https://pubmed.ncbi.nlm.nih.gov/32644741/