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A 58 year old man presented was with the acute onset of language disturbance. He had fluent speech which made no sense. His could not follow any commands. He frequently substituted sound-alike words for the correct words, and at other times, used made-up words.
Axial CT scan 3 days later shows a large lesion in the left temporal and posterior parietal lobes, in the distribution of the inferior division of the middle cerebral artery. Lesions in this area result in a fluent aphasia with impaired comprehension and repetition (i.e., Wernicke's aphasia). This type of stroke is almost always due to an embolus, either artery-to-artery or cardio-embolic. As the frontal and anterior parietal lobes are spared (supplied by the superior division of the MCA), the patient is not weak or numb. Stroke is this location can easily be misinterpreted as primary psychiatric disease.
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