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Middle cerebral artery language territory — MRCPsych Paper A MCQ

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HardNeuroanatomyMiddle cerebral artery language territoryMRCPsych Paper A

A 58-year-old right-handed woman develops sudden language disturbance. Her speech is fluent and normally articulated but contains semantic paraphasias and neologisms. She cannot follow spoken commands, repeat a phrase or name common objects. Limb power is normal, but visual-field testing shows a right superior quadrantanopia. CT angiography demonstrates a distal left middle cerebral artery occlusion. Which vascular-anatomical lesion best accounts for this presentation?

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Correct answer: D — Dominant posterior perisylvian cortex supplied by the inferior division of the left middle cerebral artery

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

A is correct. Fluent but meaningless speech, markedly impaired comprehension, naming and repetition constitute a Wernicke-type aphasia, localising to the dominant posterior perisylvian language network, particularly posterior temporal cortex. This region lies in the inferior division of the left middle cerebral artery territory. A right superior quadrantanopia can result from accompanying involvement of left temporal optic radiations, while preserved power argues against substantial superior-division motor-cortex involvement. Option B would more typically cause non-fluent speech, often with right face-arm weakness. An anterior cerebral artery lesion may cause leg-predominant weakness or abulia rather than this aphasia. A right inferior parietal lesion causes left visuospatial neglect. A left posterior cerebral artery lesion may cause a right homonymous hemianopia and, with splenial involvement, alexia without agraphia.

Reference: Charbonneau L, et al. Anatomy and Structural Connectivity of the Opercula. Journal of Clinical Neurophysiology. 2026; online ahead of print. https://pubmed.ncbi.nlm.nih.gov/42328755/