Basic Human Neuroanatomy
A Clinically Oriented Atlas 

Case History #42

Date of Consultation: 5-3-1987



This 64-year-old right-handed white male retired shipbuilder was admitted to the hospital for difficulty with speech and right-sided symptoms.  Approximately 3 hours prior to admission, the patient had the acute onset of a funny sensation in his right hand and difficulty with his speech.  His speech difficulty consisted of speaking very slowly and occasionally missing or blocking on a word.  On the way to the hospital the funny sensation in his right hand spread to involve the entire right upper limb and part of the right lower limb.  In the emergency room a CT scan of the brain was done and was entirely normal.

The patient's past medical history was significant for a prior MI, a coronary artery bypass graft operation, and a past history of heavy smoking. 


Mental Status Exam:  The patient was awake and alert.  He was oriented to person, place, and time.  Within the constraints of his language dysfunction, there appeared to be no deficits of memory.  The patient did produce fluent speech, although he spoke very slowly and would often stop in the middle of a sentence as if he were searching for a word, phrase, or concept.  He had no problem comprehending spoken language and was able to follow commands without difficulty.  He was able to repeat test phrases.  He had difficulty in naming objects.  He had difficulty with writing, calculations, recognizing body parts on the right side including his fingers, and tended to confuse the right and left sides of his body.  His mood was somewhat depressed.

Cranial Nerves:  Intact.

Motor System:  Intact.

Reflexes:  Intact and symmetric.  Plantar reflexes were flexor bilaterally.

Sensory System:  Intact.

Cerebellar Function:  Intact.

Gait and Stance:  Not tested.



1.  What is the term describing this patient’s difficulty with writing?

2.  What is the term describing the patient’s difficulty with calculations?

3.  What is the term describing the patient’s failure to recognize body parts (including fingers)?

4.  What is the term describing the patient’s difficulty naming objects?

5.  The findings in this case represent a classic neurologic syndrome.  What is the name of that syndrome?  Damage to what area(s) of the brain gives rise to this syndrome?  Indicate the side of the lesion.

6.  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.

7.  In general, what type of pathologic process was involved in this case? 

8.  What diagnostic procedure(s) would you undertake at this point?

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