DIAG 2740 Chapter 19 Case Studies

DIAG 2740 Chapter 19 Case Studies - Chapter 19 Cases Case...

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Chapter 19 Cases Case #1 Acute Severe Aphasia, With Improvement Chief Complaint A 74 year old woman was brought to the emergency room because of sudden inability to speak and right handed weakness. History One month prior to admission, the patient was diagnosed with atrial fibrillation associated with hyperthyroidism. Her medications included coumadin anticoagulant, but she may have been noncompliant. During dinner on the evening of admission, she suddenly stopped speaking and was noted by her family to have right side weakness. By the time they brought her to the emergency room, the right side weakness had mostly resolved, but her speech remained abnormal. Physical examination (hospital day 1) Vital signs: Temperature = 99.1º Pulse = 100 BP = 138/84 Respiration = 20 Neck: supple with no bruits, thyroid slightly enlarged. Lungs: crackles at the bases bilaterally. Heart: irregular rate, tachycardic; 2/6 systolic murmur heard at the apex. Abdomen: normal bowel sounds, nontender. Extremities: no edema Neurologic exam: Mental status : alert 1. Spontaneous speech: marked paucity of spontaneous speech; said only single words and rare rote phrases, such as “no” (inappropriately) “I can’t,” or “I don’t know.” Cleared throat as if about to speak, but then didn’t say anything or said very little. Uttered occasional meaningless paraphrasic phonemes. Voice dysarthric and hypophonic. Did better with rote tasks and singing. For example, once the examiner got her started, the patient was able to continue counting up to 7, and sing a few phrases of “Happy Birthday.” She appeared frustrated by her difficulties. 2. Comprehension: followed no commands correctly except, “close your eyes.” Did not answer yes/no questions or point appropriately at named objects. Did imitate or obey gestures occasionally and caught on to tasks on the basis of context. 3. Repetition: could repeat “no,” but not “cat,” “Alice,” or other words. 4. Naming: named no objects. 5. Reading: unable to read.
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6. Writing: scribbled with pen, producing no letters. Cranial nerves : pupils 3 mm bilaterally. Preserved blink to threat bilaterally. Extraocular movements intact. Corneal reflex intact, bilaterally. Marked weakness of the right face, sparing the forehead. Normal gag. Motor : normal tone. Finger taps slightly slower on the right. Normal strength bilaterally, but testing limited by motor impersistence. Able to use both hands well when putting on socks. Reflexes : grade 1+ throughout, with normal plantar response. Coordination : no ataxia of arm movements when reaching for objects bilaterally. Gait : somewhat tentative but narrow based. Sensory : flinched equally in response to pin prick in all four extremities. Follow up exam (day 3)
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DIAG 2740 Chapter 19 Case Studies - Chapter 19 Cases Case...

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