William is a right-handed man in his late 60s who has been noticing a progressive difficulty in recognizing spoken words (this actually began nearly 10 years ago). He has a decade-long history of hypertension, although his doctors had thought this was well-controlled with medication.
As his difficulties progressed, he also began experiencing problems with speaking (mild, but still noticeable). When his daughter spoke to him, William often showed difficulty in understanding what she said, although when she wrote him notes, William understood those perfectly well.
Interestingly enough he has had no problem with recognizing environmental (non-speech) sounds, and has been able to carry on his work as a farmer with no problems.
When William finally saw his doctor, a neurological exam revealed few abnormalities. He had no paresis, and the muscle tone in his extremities was normal. However, when he spoke William always seemed to be shouting, and yet there was no evidence of a hearing deficit.
William was referred for a full neuropsychological evaluation. The team evaluating him noted that his voice was abnormally loud, explosive, and quite dysprosodic. William continued to show difficulty in understanding words that were said to him, and was unable to complete any repetition tasks. He still read quite well, though when he read aloud his voice was quite loud and his tone was odd.
While William was being evaluated, he often mixed up his words or substituted nonsense syllables without being aware of it. This happened more often when he was asked to name objects rather than in spontaneous conversation. However, his doctors noted that evaluation was difficult: often William was unable to repeat instructions because of his inability to understand what was being said to him. When instructions were written down for him, however, William did not exhibit as many of these problems. Also, his writing was quite fluent and contained few of these substitution or other errors.
Questions
- What condition or conditions (there may be more than one possibility) are being described in this case?
- What brain area or area(s) may be involved (be sure to consider which language functions are compromised too, and be specific as to which hemisphere)? How should they function normally? What could be causing this dysfunction?
- What do the patient’s symptoms tell you about his language abilities and how they may be impaired?
Originally published at http://www.sciencecases.org/mini_aphasia/1william.asp
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