Sunday, September 6, 2009

Interesting case

I have a patient at the moment who presented to hospital with confusion +++ and a severe UTI. Over the last few months he has been declining in cognition and has become more regularly confused and disorientated. His UTI definitely exacabated his confusion and he became more aggressive also.
When i first met the man he was disorientated to time, place and person and was being aggressive towards the nursing staff. At this time he was also having difficulties answering questions but it was hard to determine whether this was difficulties with attention, comprehension or expression.
It is now 4 days later, and he is more orientated to time, place and person. HOwever he is still having difficulties answering questions
e.g. what city are we in - he verbally said the wrong answer but when asked to write it down he got it correct
This tends to suggest he was having difficulty expressing..however when asked to say his date of birth he got the numbers mixed up e.g. 24 Month 1922 instead of 22 Month 1924. When asked to right it down he still couldn't figure it out, and there were some cross outs and several attempts made.

His wife reports he has had difficultly over the last month expressing what he wants e.g. he asked for an ice berg when he wanted an eskimo pie ice cream. When his wife tries to figure out what he means and gets it wrong or cannot guess he gets very angry and frustrated.

I have decided to do an HDS cognitive screen as his memory, registration and ?attention are concerning. I would like to do a broader assessment before i took into his difficulty expressing what he wants. It appears he knows what he wants to say but is having difficulty expressing it - like a verbal expressive aphasia

From researching this i have found some interesting information ...

Expressive aphasia, known as Broca's aphasia in clinical neuropsychology and agrammatic aphasia in cognitive neuropsychology, is an aphasia caused by damage to or developmental issues in anterior regions of the brain, including (but not limited to) the left posterior inferior frontal gyrus known as Broca's area
Middle cerebral arteries supplies this area
Aphasia's usual result from brain lesion

Anyway this all needs further investigation and definitely follow up in the community perhaps with the community rehab team
I know the medical team were planning a CT scan - be good to follow this up also


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