After a stroke destroyed part of Juan’s left hemisphere, it became very difficult for him to produce speech. He primarily relied on high-frequency content words to get his meaning across, and also had problems with repetition and grammar. He did not have problems with understanding speech, however. These symptoms are most likely associated with which of the following disorders?

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BlackTom AI · Accepted Answer

When evaluating language disorders after a left-hemisphere stroke, we look at which aspects of language are impaired and which are preserved, along with the anatomical regions typically involved.
Option a. 'a. Broca’s aphasia' — This aligns with the symptom pattern described: nonfluent speech, reliance on high-frequency content words (telegraphic speech), impaired repetition, and grammatical difficulty, while comprehension remains relatively intact. This constellation is classic for Broca’s (expressive) aphasia due to damage to the inferior frontal gyrus (Broca’s area).
Option b. 'b. Wernicke’s aphasia' — Wernicke’s aphasia involves fluent, often paraphasic speech with poor comprehension and little awareness of errors. Here, comprehension is described as intact and speech is nonfluent rather than fluent, making Wernicke’s aphasia unlikely given the preserved understanding.
Option c. 'c. Transcortical Motor aphasia' — This condition shows reduced speech output and a nonfluent speech pattern similar to Broca’s, but with preserved repetition because the arcuate fasciculus is intact. The case notes emphasize impaired repetition, which argues against transcortical motor aphasia.
Option d. 'd. Global aphasia' — Global aphasia results from widespread left-hemisphere damage and typically features severely impaired language across modalities: both expressive and receptive language are compromised. The patient in the scenario preserves understanding, arguing against global aphasia.
Option e. 'e. Conduction aphasia' — Conduction aphasia is characterized by fluent speech with meaningful content but poor repetition and relatively good comprehension; patients often nod along but struggle to repeat phrases exactly. The described language profile emphasizes nonfluency and grammar problems, not a primary repetition deficit with fluent output, making conduction aphasia an unlikely fit.

In summary, the pattern of nonfluent, grammatically impaired speech with preserved comprehension most closely matches Broca’s aphasia, while the other listed disorders either involve fluent speech with poor comprehension (Wernicke’s), preserved repetition with fluent speech (conduction), limited but widespread impairment (global), or a motor-speech variant with preserved repetition (transcortical motor) that does not align with the reported repetition deficit and grammatical issues.

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