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Wernicke aphasia — MRCPsych Paper A MCQ

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EasyNeuroanatomyWernicke aphasiaMRCPsych Paper A

A 59-year-old woman develops a language disturbance after an ischaemic stroke affecting the dominant cerebral hemisphere. Her speech is fluent and grammatically formed but contains paraphasias and little meaningful content. She has markedly impaired spoken-language comprehension and cannot repeat a short phrase. Damage to which structure or region best explains this presentation?

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Correct answer: C — Dominant posterior temporal language cortex (classically Wernicke area)

The correct answer is C. Fluent, grammatically structured but paraphasic and low-information speech, together with poor comprehension and impaired repetition, is the classical pattern of Wernicke aphasia. It follows damage to the dominant posterior temporal language network, traditionally termed Wernicke area. Modern models emphasise that comprehension depends on a distributed network rather than one sharply bounded cortical centre, but D remains the best examination localisation. Broca-area damage causes effortful, non-fluent speech with relatively preserved comprehension. An arcuate fasciculus lesion causes conduction aphasia, in which repetition is impaired but comprehension is comparatively preserved. Nondominant posterior temporal damage is more associated with impaired emotional prosody, while angular gyrus lesions classically cause alexia, agraphia or Gerstmann-type deficits rather than this complete syndrome.

Reference: Royal Wolverhampton NHS Trust/Stroke Association. Communication problems after a stroke, section 'Types of aphasia', 2023. https://www.rwt.nhs.uk/PIL/MI_12151514_01.08.23_V_1.pdf