Neurological Examination — Speech and Higher Mental Function

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Target exams

Red flags

• Acute onset of fluent, copious, meaningless speech with poor comprehension is Wernicke aphasia from a dominant-hemisphere superior temporal infarct — investigate and manage as an acute stroke within the thrombolysis window
• A patient who suddenly stops speaking or produces only effortful, sparse, telegraphic fragments may have an acute Broca aphasia from an inferior frontal lobe stroke — examine for right hemiparesis and activate the stroke pathway
• A fluent aphasia with preserved repetition that evolves over weeks to months, or a progressive anomia, is primary progressive aphasia — a neurodegenerative syndrome, not a stroke, and needs urgent neurology and MRI
• An acute confusional state can mimic a Wernicke aphasia — the speech is incoherent and comprehension appears poor, but the disordered thinking, fluctuating attention and altered consciousness point to delirium, not a focal language lesion
• Acute dysarthria with facial and limb weakness is brainstem or hemisphere stroke until proven otherwise — dysarthria is a recognised stroke warning sign and warrants urgent imaging, never attribution to intoxication or fatigue alone