Basic Human Neuroanatomy
A Clinically Oriented Atlas 

Case History #152

Date of Admission: 5-31-2008


This 75-year-old right-handed Puerto Rican female was admitted to the neurology service because of recent onset of language dysfunction.  The patient’s daughter indicates that for the past 3 to 4 days she has had intermittent word finding problems.  The daughter indicates that the patient is able to comprehend what is being said to her.  She also is able to produce fluent speech.  However, at times, she blocks on words and has difficulty coming up with specific words or concepts.  This has not been a consistent problem but has been present intermittently for the past 3 or 4 days.

The patient had similar problems in the past, and her daughter indicates that these symptoms were more severe at that time.  The patient is known to have hypertension and hyperlipidemia.


Mental Status Exam:  The patient was awake, alert, and fully oriented.  Memory function was intact.  The patient was able to produce fluent speech and had intact comprehension.  She was able to repeat simple test phrases.  She had difficulty naming objects and intermittently appeared to block on words.  She also had some difficulty with writing.  There was no left-right confusion, and she was able to recognize body parts on both sides of the body.  The patient’s mood was pleasant and cheerful. 

Cranial Nerves:  Cranial nerve examination was entirely normal, except for severe impairment of vision in both eyes due to glaucoma.

System:  There were no areas of focal or generalized muscular atrophy.  There were no fasciculations.  Muscle tone and power were normal in all four limbs. 

  Deep tendon reflexes were equal and symmetric, and the plantar reflexes were flexor bilaterally. 

System:  Intact.

Function:  Intact.

and Stance:  Regular and tandem gait were performed normally, and the Romberg test was negative.


1.  How would you characterize this patient’s language dysfunction?  Damage to what area of the brain typically gives rise to this type of language dysfunction?  Indicate the side of the brain involved.

2.  In general, what type of pathologic process do you think is involved in this case?
3.  What diagnostic procedure(s) would you undertake at this point?

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