[Dysphagia] Aphasia - off topic sorry

[kwspeech at yahoo.com (kathy)]

The naming sounds like a visual agnosia

Sharon Manders <cmandersn223@rogers.com> wrote:Hi,

I know this is off topic, but since it is a neuro case, some people 
may have seen this before.

I have a pt who has suffered 3 CVAs, the most recent being about 10 
days ago. Swallowing has recovered fully. His 1st CVA was a R frontal 
CVA in 1998, leading to aggressive, disinhibited behaviour. He spent 
close to $100,000 which his wife took 7 years to pay off, and tried 
to throw her through a window. He then had another CVA in 2000 
(unclear where) which actually made him less aggressive. In between 
was a MVA, with no documented (in this hospital) neuro involvement - 
mostly physical.

After this last CVA, he has presented with an unusual receptive 
aphasia - at first it seemed like an apraxia of his auditory 
processing skills (that's the only way I can describe it). Direct 
questions he answers with I don't know or some other phrase. When 
asked a verbal question, and given written choices, he is almost 
always correct (80-90%). When I first assessed him, he had a lot of 
trouble and was doing his best to cover for it. As an aside I asked 
him if he wanted apple or orange juice and he replied "Oh, apple, 
please, I prefer that to orange". He is bilingual Greek/English, his 
wife reports the same problems in Greek. His memory is almost 100%. 
The OT ax, part of which I observed, said that his executive 
functioning was intact, he can ask for help if he doesn't know where 
he is going, he knows to read signs, he asked the nursing station 
which room he was in and gave his full name so they could look him up.

When I checked his naming he was unable to name 'pen', saying instead 
- Isn't that beautiful. When shown a 'key', he said 'car' in Greek. 
With a 'cup', he said 'water' and I could not get him to name the 
'holder' as he said he was tired and had had enough. His 
conversational skills would appear normal to anyone passing by. He 
remembers the names of all the therapists and is socially appropriate 
with us. Last weekend he had an outburst which required security to 
put him in 4 point restraints! Today he is pleasant again.

I have never seen such an unusual and interesting presentation. He is 
likely to go home with the wife and I have told her that he seems to 
do best (or is at least consistent) with written information.

Are there any other ideas for Ax or treatment that I can do before he 
leaves?

Thanks for any and all help in advance.

Sharon
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia



Kathy Walker



		
---------------------------------
 Yahoo! Music Unlimited - Access over 1 million songs. Try it free.