This patient’s receptive aphasia, right upper homonymous quadrantanopsia, and CVA risk factors are concerning for stroke secondary to occlusion of the inferior division of the left MCA.
Region A corresponds with the, which is involved in the and is important for memory formation; it is supplied by the posterior cerebral artery and is particularly vulnerable to ischemia. Ischemic stroke involving the hippocampus would result in rather than the fluent aphasia and visual field defects seen in this patient.
Region C corresponds with the insula, a complex structure involved in perception, somatosensory processing, visceromotor functions, and cognition. Ischemic injury to this region is extremely rare and can have variable presentation, including vestibular, motor, somatosensory, speech, and/or cardiac conduction abnormalities. Insular strokes are most commonly associated with nonfluent aphasia; the combination of a fluent,and right upper homonymous quadrantanopsia in this patient is not consistent with an insular stroke.
Region D corresponds with the inferior frontal gyrus, which is an important region for language and comprehension and is supplied by the superior division of the MCA. Ischemic stroke involving the inferior frontal gyrus classically presents with, which is characterized by nonfluent speech deficits and relative sparing of comprehension. This patient has evidence of fluent aphasia, making injury to the inferior frontal gyrus unlikely.
The patient’s presentation of optic radiations (Meyer loop) in the temporal lobe. His and medical noncompliance suggest a as the underlying cause.and right upper is most consistent with an ischemic injury to the (region E) due to an ischemic stroke involving the inferior division of the left MCA. His visual field deficits are the result of the involvement of the inferior fascicle of the left