Stroke
E Glucksman in MCQs in Neurology and Neurosurgery for Medical Students, 2022
This chapter encourages quick, focused study and detailed answers aid comprehension of stroke with essential diagrams, colour images and sample MRIs. A posterior circulation stroke can be ruled out, as this would present with a variety of unique symptoms such as cerebellar dysfunction and nystagmus. A lacunar infarct would not cause expressive dysphasia, which would require damage to the dominant left temporal lobe. Kluver-Bucy syndrome presents with the clinical triad of hyperorality, hypersexuality and disinhibited behaviour. An ischaemic stroke, encephalitis and Alzheimer’s disease can cause it. The location of the lesion responsible for this presentation is the amygdala (bilateral lesion), which is involved in memory, emotion and sexuality.
Case 14
Edward Schwarz, Tomos Richards in Cases of a Hollywood Doctor, 2019
You are asked to see a patient who has been brought in by ambulance to the emergency department. You understand he is from Tasmania and that his family were concerned that the patient woke up this morning with one side of his face appearing to be drooping and he was salivating on that side. He also was finding it frustrating as he was unable to get his words out. This was making him more annoyed. He is not a smoker but his family report he is always fairly stressed out and he is a diabetic. On examination he has marked facial droop, expressive dysphasia and some subtle right-sided weakness, and you note that he is in atrial fibrillation.
Dysphagia
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
The causes of dysphagia may be classified into neuromuscular and obstructive categories. Disruption of the neuromuscular control of swallowing may occur at the level of the central nervous system, the peripheral nerves or the pharyngeal and oesophageal muscles. Patients with neuromuscular dysphagia may be at risk of aspiration if they are allowed unrestricted oral intake. Examination of the mouth and pharynx should not be performed without anaesthetic support and full resuscitation facilities if airway compromise is a possibility, as it may precipitate complete airway occlusion. Hemiparesis, hemisensory loss, dysphasia, dyspraxia, visual neglect or homonymous hemianopia suggest a cerebral lesion. Abnormal, uncoordinated or involuntary movement may occur with degenerative, demyelinating or inherited disorders of the central nervous system. Bulbar palsy is characterised by nasal speech, tongue wasting and fasciculation, and an absent gag reflex. Pseudobulbar palsy is char-acterised by spastic dysarthria, a brisk gag reflex and jaw jerk, and emotional lability.
Time to talk: counselling for people with dysphasia
Published in Disability and Rehabilitation, 1996
Chris Ireland, Geraldine Wotton
In this small-scale qualitative study, 20 dysphasic people, including some with severe language impairments, were offered up to 20 sessions of individual counselling. The trained counsellors were a speech and language therapist and a teacher who had personal experience of dysphasia. The paper describes how the service was set up, and how it was evaluated through the use of interviews before, during and after the process of counselling. In general, participants valued the service and a number of positive outcomes were described. Negative reactions were largely due to problems with the setting, timing and organization of the counselling and to the presence of social problems which could not be addressed through counselling. A number of recommendations for setting up a counselling service for people with dysphasia can be drawn from this study. These are discussed in this paper, together with the issues arising from the collaboration between dysphasic and non-dysphasic researchers.
An unusual aneurysm of a basilar perforating artery presenting with a subarachnoid haemorrhage
Published in British Journal of Neurosurgery, 2013
Vino Apok, Andrew Tarnaris, Howard L. Brydon
A 65-year-old man had a perimesencephalic subarachnoid haemorrhage with normal angiography initially. After a rebleed 5 days later, a repeat angiogram revealed a pea-like aneurysm a short distance behind and below the basilar bifurcation. It was not amenable to endovascular treatment and the feeding vessel was coagulated and divided at open surgery via a sub temporal approach. He developed a right hemiparesis and dysphasia, from which he slowly recovered. Basilar perforating artery aneurysms are extremely rare, with only 4 previous cases reported.
Speech bubble: dysphasia secondary to spontaneous intraparenchymal pneumocephalus
Published in British Journal of Neurosurgery, 2020
Rathijit Mitra, Ashwin Kumaria, Stuart Harrisson, Julian Cahill
Spontaneous pneumocephalus is exceptionally rare, with few published cases in the literature. We describe a patient presenting with dysphasia, right facial weakness, headache and confusion who was subsequently found to have pneumocephalus due to an encephalocoele herniating into a tegmen tympani defect.
Related Knowledge Centers
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