Gerald is a 60-year-old right-handed man who has suffered a medial cerebral artery infarction that initially resulted in a severe expressive aphasia and right-sided hemiparesis (weakness). After one year of speech therapy, his articulation improved, although it was still somewhat labored. In addition to this, he was severely impaired in his ability to name objects. When confronted with pictures, he was only able to name 47 out of 114 pictures. However, he was significantly better at reading words and sentences aloud. He showed no signs of paraphasia (inappropriate word substitutions), and his writing was only mildly impaired.
Here is an example of a conversation between Gerald and his doctor:
Doctor [holding up a coffee cup]: Can you tell me what this is?
Gerald: Oh boy, you know … isn’t that funny, oh I know, it’s one of those things, … geez … it’s something that you hold, right? … Uhmm … it holds stuff …
Doctor [now showing a pencil]: How about this?
Gerald: Um … ok … I know what that is … isn’t it something you use to … you know … oh darn it … you use it to write, I think … It’s one of those things that … Ugh! … I must be getting old.
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/4gerald.asp
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