A Case of WERNICKE'S Aphasia

AN INTERESTING OF

IRRELEVANT SPEECH

Dr.ARUL SELVAN UnitPresenter: Dr.M.RAMESH BABU

Brief History

• Mr. X 72 yrs old gentleman, businessman,

Hypertensive, smoker presented with chief ℅

• Sudden onset of repetitive speech

• Irrelevent talk

• Restlessness -

30minutes.

• HOPI: Pt. was apparently normal before at 5

pm he went to wash room, came out and told

that he is not feeling well and lyed on the bed.

• from 5:40pm he started keep on repeating

kids..kids…kids.. (they went to school not at

reached home)

• family members try to talk to him but they came

to know that he is not in a communicative

state.

• Immediately brought to ER at 6:15pm.

• No h/o headache / LOC/nausea/vomiting/ limb

weakness/deviation angle of mouth/ vision

disturbance/ TIA in the past.

• no h/o fever/ night sweat/ loss of appetite/ loss of

weight loss.

• no h/o hallucinations / abnormal behaviour before

/ no psychiatric illness

• H/o Hypertensive on Rx T.Concor 2.5mg OD , Not

a Diabetic, CAD

• H/o retinal detachment - 10yrs back.

• no travel history

• no other drug usage (ayurvedic or

homeopathic)

• no toxin exposure

• no h/o any recent vaccination

History Summary

• 72yrs old gentleman, businessman,

hypertensive, smoker came with ℅ sudden

onset of Sudden onset of repetitive speech,

irrelevant talk and restlessness

- 30minutes without dysarthria, headache,

fever, nausea, vomiting, visual disturbance,

limb weakness, imbalance while walking.

• Probable diagnosis: Wernickes’s aphasia

• encephalitis /

encephalopathy

On Clinical Examination

• No pallor/cyanosis/clubbing/pedal

oedema/lymphadenopathy/thyroid swelling

• Vitals - PR-78/min, B.P - 190/100mm of hg

• CNS Examination:

• Pt. is conscious, irritable, agitated

Speech

• Speech:

• Spontaneous speech - Fluency is good (

Repetitive talks, neologism +)

• Repetition - impaired,

• Comprehension - impaired

• Naming - impaired

• Reading & writing - not cooperative.

• Pupils- B/L 3mm Reactive, fundus- normal.

• EOM- Full,No ptosis,

• No facial lag

• Other Cranial nerves examination - normal

• Motor system: tone -normal, power 5/5 all 4 limbs,

DTR’S - 2+, plantar - flexors

• Sensory - Not able to check

• no cerebellar signs

• no meningeal signs / no neckstiffness

• other systemic examination - normal.

• CT brain - Normal and angiography -

thrombosis of Lt. parietal branches of M2.

• Patient was within the window period -

Thrombolysed immediately within 40 minutes

with IV Tenectaplase dosage of 25mg (double

dose) and started on antiplatelets and statins

after 24 hours of thrombolysis.

• Patient status - Post Thrombolysis - Not much

beneficial.

MRI

MRI & MRA

Investigations • Hb% - 14.3gm%

• PCV- 43%

• WBC- 7810 cells

• Platelets - 2.3lakhs

• Blood glucose - 109 mg/dl

• B.urea - 33mg/dl

• S.Cretinine - 1.05 mg/dl

• S. Na - 139 , K+ - 3.8 , LFT - normal

• PT - 12/12, INR - 1.0, PTT - 30 /27

• ECG - RSR, ECHO Heart - Normal LV fun. EF- 65%, no

RWMA

Final diagnosis

• Acute ischemic infarct - MCA territory - inferior

divison or its branches

• Wernickes’ apahsia

• Which may be beneficial Tenectapalse vs

alteplase ?

• Low dose vs high dose Tenectaplase ?

Approach to a case of Speech

disorder

• Aphasia- is true language disturbance in which

patient demonstrates an impaired production or

comprehension of spoken language.

• Dysarthria- a specific disorder of articulation in

which basic language intact.

• Alexia – is loss of reading ability

• Agraphia- loss of writing ability.

• Dysprosody- is an interruption of speech melody.

Neuroanatomy

• Auditory cortex-reception of spoken language.

• Wernicke’s - area-decoding of sounds into

linguistic information.

• Brocas area- spontaneous speech and repetition

• SMG-phoneme processing in comprehensionand

phoneme production for repetition and speech

• AG-processing of visual language into

auditory language information

• Arcuate fasciculus- connects sensory and

motor language areas.

• Role of subcortical structures :

• Thalamus - a relay station for RAS, appears to

alert the language system

• Basal ganglia-involved in expressive speech

Evaluation

• Spontaneous speech

• Comprehension

• Repetition

• Naming

• Reading

• Writing

Approach

THANK YOU