Chandregowda, Adithya

Purpose: This case report aims to raise awareness among health care professionals and students that acute onset Wernicke's aphasia could be misinterpreted as delirium. In such a context, a patient's psychological/emotional reactions (e.g., agitation, anger) to aphasia associated communication breakdowns can be mismanaged as primary psychiatric concerns. Conclusion: Preliminary suggestions for relevant clinical practice are offered.

Introduction: In the context of Alzheimer’s disease phenotypes, patients may present with symptoms and signs that do not exclusively fit into one of the existing phenotypic categories, which often delays timely diagnosis and initiation of services to optimize patient awareness and coping. Case Report: A 74-year-old woman presented with the complaint of progressive word-finding difficulty, raising our suspicion for primary progressive aphasia. Clinical evaluations, however, also revealed emerging cortical visual deficits consistent with posterior cortical atrophy. During evaluation 1 year later, Gerstmann syndrome was evident. Her in vivo neuroimaging was positive for beta-amyloid and tau biomarkers of Alzheimer’s disease pathology. Conclusion: In addition to contributing to the literature on the heterogeneity of the clinical manifestations of Alzheimer’s disease, this report highlights that a breakdown in the visual-lexical interface can account for anomia in posterior cortical atrophy at least in some cases. Other relevant clinical insights pertinent to this case are discussed.

AbstractA 57‐year‐old man presented with dynamic aphasia with evolving agrammatism and anomia. Additionally, he exhibited emerging atypical parkinsonism and features of behavioral variant frontotemporal dementia. Insights pertinent to this complex clinical presentation are discussed.

We describe two individuals with progressive verbal difficulty who exhibited impairment of propositional language, with relatively well-preserved auditory comprehension, naming, and repetition—a profile that is consistent with dynamic aphasia. By providing a brief review of pertinent literature and the results from our neurologic, speech and language, neuropsychological, and neuroimaging testing, this report sheds light on the infrequently reported dynamic aphasia in the context of frontotemporal dementia. Our patients’ insights into their verbal difficulty tend to support the notion that dynamic aphasia results from interference at the stage where thoughts are converted into verbal messages—that is, the thought–verbal interface.

Purpose: The purpose of this clinical focus article is to illustrate how speech-language pathologist (SLP) characterization of anarthria can contribute to neurological diagnosis and to highlight the challenges associated with such an endeavor. Method: Used in this study are a retrospective chart review and clinicians' experience-based reflections. Results: A 65-year-old man, who, in the context of a neurodegenerative disease, presented with near-complete-loss of speech, was referred by neurologists to SLPs for further characterization of his speech difficulty. Assessment of his limited speech output revealed anarthria with mixed features (spastic and hypokinetic) with superimposed apraxia of speech. Conclusions: SLP characterization of anarthria to facilitate neurological diagnosis is challenging but possible. Clinical lessons learned from this unusual scenario are discussed.

Purpose The purpose of this report is to promote conversation among medical speech-language pathologists (SLPs) about their role in facilitating family–patient interaction involving patients who acutely encounter the end-of-life (EOL) phase and have severe communication impairment. Case Report We provide self-reflections from our own clinical practice, pertinent literature review, and medical chart review of a relevant patient to serve as a catalyst for such discussion. Reflections We share a preliminary handout containing strategies that SLPs could provide family members of patients who have encountered an EOL phase and have severe communication impairment (e.g., global aphasia) and reduced alertness level. Clinical Implications SLPs can play an important role in facilitating EOL patient–family interaction and alleviate suffering even when patients have severe communication impairment.

Purpose The purpose of this report is to raise awareness among medical speech-language pathologists about challenges associated with encountering primary progressive aphasia patients in the acute hospital setting. Method Retrospective medical chart review. Results A 68-year-old woman was hospitalized for hyponatremia, pneumonia, and toxic-metabolic encephalopathy but was also noted to be suffering from chronic verbal difficulty for which medical attention was not sought previously. An interdisciplinary approach to address her verbal difficulty led to the diagnosis and initial management of a neurodegenerative disease characterized primarily by aphasia and apraxia of speech. Conclusion Service implementation lessons learned from this case study in terms of diagnosis and management and patient's illness experience are discussed.

Introduction: Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a multisystemic mitochondrial disorder that usually presents in childhood. Patients can have a wide array of neurological symptoms when presenting with stroke-like episodes, and imaging characteristics during the episodes can overlap with different neurological disorders. Case Report: A 61-year-old woman presented with communication difficulties consistent with auditory agnosia and was found to have bitemporal abnormalities on imaging that first raised the concern for herpes simplex virus encephalitis. Further work-up, in conjunction with the patient’s past medical and family history, suggested a mitochondrial disorder. Mitochondrial full genome analysis revealed m.3243A>G variant in the MT-TL1 gene, with 6% heteroplasmy in blood leading to a diagnosis of MELAS. Conclusions: MELAS is a disorder with clinical variability. Neuroimaging studies during stroke-like episodes in MELAS can provide significant clues to the underlying disorder. Although patients typically present in childhood, the first stroke-like episode can occur later in life in some patients, potentially related to a lower heteroplasmy level.