Paul Broca, Carl Wernicke and Pierre Marie have contributed significantly to the study of speech. Pierre Marie’s contributions have received far less recognition in current practice. The quadrilateral space of Pierre Marie includes the lenticular nucleus, internal capsule, insula, and the deep underlying white matter. Pierre Marie (1906) believed that pathology in the quadrilateral space produced a severe disturbance of verbal output called anarthria.

We present a case of anarthria caused by a lesion in the quadrilateral space of Pierre Marie.

43-year-old male with a history of prior right basal ganglia stroke, hypertension, diabetes mellitus type 2, smoking, hyperlipidemia presented with slurred speech and right sided weakness. He became anarthric a few hours after admission, with worsening weakness of his right side. Patient was also noted to have difficulty managing his own secretions, and inability to open his mouth. Work up included CTA head and neck which revealed moderate stenosis of the right inferior branch of the middle cerebral artery. MRI brain revealed an acute stroke involving the left lenticular nucleus, posterior limb of the internal capsule, insula, and the deep underlying white matter. His deficit was severe because of bilateral lesions that impeded compensation by the contralateral hemisphere.

Anarthria is a severe form of speech disorder originally described by Pierre Marie. Recognition of this clinical entity, and its anatomic basis will help in early localization and understanding of this speech disorder in clinical practice.