Concluded Case

Left MCA acute infarction with Wernicke's Aphasia

The relatives noted acute onset of difficulty to communicate,in the form of putting meaningless words and sentences and inappropriate answers In a 57 yr old ,female with back ground history of DM type 2. Chief Complaints The husband and children noted acute onset of talking nonsense on 13 th morning onwards. Denied having any head ache,vertigo or vomiting. No seizures. No motor weakness noted by the relatives.Evaluated by the psychiatrist, and attended the OPD.I asked only one question Mam,How do you feel now and what is your problem? Immediately she answered,"walking to the shop,registered ,took bath in the shop and she laughed and finally said got fish"I replied thanks,immediately she said this is the time for lunch. . History Detected to be a Type 2 DM.No family history of stroke or malignancy. Non smoker. No H/ o of ethanol intake Vitals Afebrile BP 140/ 80 mmhg. HR 68/ mt. Physical Examination Fully concious. Speech fluent dysphasia ( already put the conversation in the history). Mild facial asymmetry. Motor system gr 5/ 5 . DTRS mild reflex asymmetry rtside.Plantas downgoing. She is responding to pain and while applying pain she was talking some inappropriate words also. No bruit over the carotids and vertebrals. Investigations Routein bloodwork up- normal. FBS 140 md/ dl. HbA1c 7%. Urine microalbuminura with in the normal limits.RFT normal Lipid profile -DLP. Dopoler neck vessels normal. MRI BRAIN DONE' keeping for discussion. Diagnosis Diagnosis -Very obvious in the MRI brain- keeping for discussion. Management Started on appropriate medicine. Including good control of DM,statin,neuroprotective,Ref to speech therapist also. Cardiac evaluation also done. DISCUSSION. What is the diagnosis?. Where is the site if lesion? What type of speech dysfunction?

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Thanks curofy and all doctors. Diagnosis very obvious- Ischemic infarction left MCA branch.On medical management,well stabilised, on speech therapy also. Discussion in this case 1.site of lesion. Large acute infarct showing diffusion restriction in the LT MCA territory involving corona radiata, head of caudate nucleus,anterior limb of internal capsule, lentiform nucleus,external capsule,insular cortex,frontal and temporal operculum. 2. What type of speech dysfunction?. Classical Wernicke's Aphasia. Fluent Aphasia. Thanks Dr Nagpal and Dr Sumeet Verma for your correct answer of speech dysfunction.

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Thanks curofy and all doctors. Diagnosis very obvious- Ischemic infarction left MCA branch.On medical management,well stabilised, on speech therapy also. Discussion in this case 1.site of lesion. Large acute infarct showing diffusion restriction in the LT MCA territory involving corona radiata, head of caudate nucleus,anterior limb of internal capsule, lentiform nucleus,external capsule,insular cortex,frontal and temporal operculum. 2. What type of speech dysfunction?. Classical Wernicke's Aphasia. Fluent Aphasia. Thanks Dr Nagpal and Dr Sumeet Verma for your correct answer of speech dysfunction.

Classic receptive aphasia, left sided Wernicke's aphasia with underlying stroke, mild effacement of Lt ventricle There appears some lesion in RT posterior cerebral area which suggests may be Mets? Or some cardioembolic stroke like picture

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Madam, sudden onset aphasia, facial asymmetry and diabetic, in first glance, wedge shaped area left mca territory, on mri suggestive of left mca infarct, but kindly upload diffusion weighted image, and ADC , on contrast no OBVIOUS enhancement, rest supportive treat , repeat ct if oedema /MLS/ neurological status down then decompressive craniectomy to be consider

Left sided ischemic. Stroke involving MCA territory with inferior branch involvement leading to wernicke’s aphasia (sensory aphasia).

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The most common cause of receptive aphasia is a stroke. A stroke happens after a lack of oxygen to the brain and is caused by a bleed or a blood clot in the brain. Receptive dysphasia can also be caused by trauma to the brain; this can be through injury, tumour haemorrhage or hematoma. Severity depends upon the extent of injury to the brain and the amount of time the brain has been subjected to lack of oxygen. Damage is usually sustained in the left side of the brain. Diagnosis of receptive dysphasia will be through a team of medical professionals, and will include a speech and language therapist. Diagnosing a patient will take many different aspects into consideration and will be done soon after initial assessments have been done in hospital. The speech and language therapist will play a key role in assessing and diagnosing a patient with receptive dysphasia. Speech and language therapy can be extremely helpful for people suffering from receptive dysphasia. A speech and language therapist will do an initial assessment and would focus on one areas tailored to each patient's difficulties. Our speech and language therapists can help individuals who have receptive dysphasia with attention and listening problems, communication problems, voice and speech problems. Speech and language therapy for someone who has receptive dysphasia will benefit their communication and understanding. It may also improve their confidence and self-esteem when interacting with others, which may provide more social and work opportunities for the patient. Speech and language therapy can help patients who suffer from receptive dysphasia. Ideally therapy would begin as soon as possible after the patient has been diagnosed. Speech and language therapy helps by offering different techniques to overcome and deal with the effects of receptive dysphasia. A speech and language therapist may use the aid of a computer assessment as well as standard measures, depending on the patient’s level of disorder. Speech and language therapy is always tailored to each individual. What would speech and language therapy treatment for receptive dysphasia involve? Speech and language therapy will involve an initial assessment to discover the next steps for treatment and to devise a speech therapy plan. After this, speech and language therapy may include assessments, reports, reviews, therapy programmes, support groups, advice and education. Specific treatment may include: Total communication approach Stroke rehabilitation group

The three most common types of aphasia are: Broca's aphasia. Wernicke's aphasia. Global aphasia1

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