VERY mild Aphasia syndrome. Stroke? Other??

[MasterDoc]

Would appreciate advice/help from Cleveland Clinic neurologist.
I am a 50 year old Emergency Physician. Six months ago I insidiously (it seemed to me) noticed what now (based on my reading) I recognize as a relatively classic (albeit EXTRAORDINARILY mild) Wernickes aphasia. It seemed to start with spoonerisms (eg "I want you to doe goo that now" instead of "go do that now"), then I noticed world substitutions with related words ie "blood sugar" for "blood pressure" or "Give the dopamine if the blood pressure goes UP at all" (when I obviously meant down). I also have since noticed some dificulty with word finding and possibly some difficulty reading aloud. These events SEEM to happen (very approximately) only 10 times a day. All these appear when I talk at a (for me) normal rate of speed. If I consciously greatly slow down my speech and attend VERY carefully to what I am saying  the frequency diminishes (eliminated?). Sometimes I notice the error though usually I don't until brought to my attention. I have had a brain MRI which revealed only a small LEFT anterior TEMPORAL arachnoid cyst (no mass effect). Two possibly related points:
1) In November I had an episode where, after donating blood, I ran for a bus. I then got very light-headed and had to get off the bus. I  I managed by force of will (this is NYC) to stay awake and upright until I saw a patch of grass where I passed out (very approx 5 minutes duration). For one hour afterward I was pale, cool and diaphoretic.NO focal symptoms noted by observer.
2) 12 years ago I had viral meningitis and had a CT scan that did NOT show any sign of an arachnoid cyst.
Now this "aphasia" is bad enough that I have decided I am unsafe to work as a mispeak in my job could easily kill someone,. I therefore need the workup done as quicly as possible so I have answers.

I went to a neurologist. SHe has ordered an EEG and cognitive testing.
I told her about the syncopal episode but she pooh-poohed it saying that since I don't have high BP or marked atheroclerosis she didn't believe that could've been a cerebral ischemic event. (WHat about marginal/watershed ischemia)?) When I expressed frustration to my internist (as an EP I KNOW that is wrong) the internist said OK but the negative MRI rules out a 6 month old stroke.
1) I KNOW that a static MRI is NOT the gold standard for old CVA> Could you give me a literature/textbook reference to show my internist that some infarcts are missed on MRI?. WHat is the generally available (accepted) gold standard for ruling out a 6 month old stroke? (and do you believe that I could have had one to explain these symptoms?)
2) I know that arachnoid cysts (p[articularly small ones) are usually asymptomatic BUT mine is non-congenital (where did it come from?) AND the coincidence of location is disturbing. Any way to prove it is irrelevant? Couldn't a very local pressure cause symptoms? How do you prove/disprove that?
3) If it's not a CVA OR the cyst what is it? Could it be primary progressive aphasia (God help me). Or something else altogether (new onset temperol lobe epilepsy at age 51?)?
ANy suggestions re differential or workup?
PLEASE help me (educationally speaking...for the lawyers...of course). And could you please check back after you answer so I could get one follow-up question in?

[caregiver222]

Yeah. I have a suggestion. Get yourself a fasting glucose tolerance test.  I am not telling you that a glucose utilization syndrome is the problem, however diabetics ocasionally develop such speech problems. It isn't helpful simply to get a "point-of-time" blood sugar reading. You need the fasting test. Are the symptoms circadian, or do they remain constant? Have you had a blood level B-12 test? Have you had an arterial blood gas at the time when the symptoms are evident? You have my admiration and respect for thinking about the effect of your disability on patient care. Let me think on this.

[caregiver222]

You have two flags for an insulin utilization syndrome. The spoonerisms (also common in the mildly intoxicated) and the orthostatic compensation problem that caused your TIA.

[chriss458]

i am one who has been told i have aphasia. i have the syncopy  episodes to were i feel i'm about to pass out. i have notice that i have difficulty with my memory. i'm getting very cofused and frustrate with my speech. can anyone tell me what to do or what to expect?