Case of the Month

Case # 4 -Answer

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Want to re-read the case before checking out the answer? See it here

 

The Answer

This patient is presenting with a physical exam finding consisting of fluent sounding speech that is meaningless. What is this physical exam finding called?
Wernicke’s Aphasia. For an astute physician she is clearly not etoh intox (or on any sedating agent) which tends to present more with slurred speech and depressed mental status.

 

Back To Fun Med School Pathophys

Two centers of language are Broca’s area and Wernicke’s area.BrocasAreaSmall

To put it simply, Wernicke’s is responsible for organizing speech into a coherent product while Broca’s is involved in the physical act of producing speech.

 

Damage to Broca's would therefore result in?
Slow, strained speech with limited words and an understandable message.

 

Damage to Wernicke's would lead to?
“fluent aphasia” – tone, pacing, hand gestures all normal, but the patient cannot express themselves with an understandable message. In addition, Wernicke’s aphasia includes inability to comprehend speech or written language.

 

Patients with injuries to these areas may present with no other neurologic deficits or symptoms at all!

 

Diff Dx

The differential includes any disease process that could damage Wernicke’s area only: neoplasm (+/- hemorrage), CVA (ischemic and hemorrhagic), cerebral abscess, encephalitis, trauma, MS (uncommon).

 

Testing/Dispo

Head CT with resulting neuro/neurosx consult and admit.

Here’s a lesion that could present like the above. On CT here it actually looks like an ischemic CVA.

IMG_20140929_114005_366

But ended up being a low grade glioma on MRI.

IMG_20140929_114152_242

 

 

By Dr. Andrew Grock

 

 References

Stephen G. Waxman, Clinical Neuroanatomy, 27e

Allan H. Ropper, Martin A. Samuels, Adams and Victor’s Principles of Neurology, 10e

Harrison’s 18th edition

Neurology 4th ed, thieme

uptodate.com

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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