LESIONS

A Guide to Localisation in Neurology

Case 11. Progressive communication difficulties

Case

A 69 year old left-handed woman developed progressive difficulty communicating.

At first she became aware of having mild word-finding difficulty, particularly in stressful situations, which was attributed to anxiety. This became worse over the following weeks, and she was eventually seen 6 weeks into the illness. She also reported difficulty with writing, though could read without difficulty.

In addition to difficulty expressing herself, she also had noted minor difficulty understanding others. Her partner reported she was sometimes making errors in speech and did not appear aware of these.

She had noted minor, intermittent, bifrontal headaches over the prior 2 months. These were not related to posture or straining. She had no other neurological symptoms and felt systemically well.

On examination she had:

• Some impairment of expressive language, with mildly dysfluent speech, at points halting to find words
• Good understanding overall, but at points, difficulty comprehending sentences and following instructions
• She was able to perform 1 step commands, but struggled with more complex instructions
• Right homonymous inferior quadrantanopia on visual field testing

The rest of the examination was normal. Speech articulation and phonation were normal.