Understanding Neurology

Disorders of cognition 101CASE 2A 65-year-old male presented to the Accident andEmergency Department with acute confusion. Thepatient was unable to give a history, but his familydescribed him as waking up talking gibberish, andunable to understand them. His behaviourotherwise seemed appropriate. He washypertensive and diabetic, but otherwise well.Although he initially appeared to be in anacute confusional state, his otherwise normalbehaviour suggests that this may be a disorderspecifically of language comprehension.On cognitive assessment, he was talkingconstantly, and unable to carry out commands.Testing of cognition was difficult on account oflack of patient cooperation. It was, however, notedthat spontaneous speech was fluent, but withnumerous neologisms. He was unable to obeycommands. Naming was markedly impaired, andhe could not comply with repetition. Readingand writing could not be assessed.It is difficult to assess nonlanguagecognitive function in the presence oflanguage impairment, as conveying what isrequired relies so heavily on language.However, the neologisms, anomia, andimpaired repetition are compatible with aprimary language disorder. Thisconstellation indicates Wernicke’s aphasia.The combination of fluent aphasia,impaired comprehension, and repetition ischaracteristic of Wernicke’s aphasia. CTconfirmed a left hemisphere haemorrhageundercutting Wernicke’s area (leftsuperior temporal region) (92).9292 Computed tomography scan showing left hemispherehaemorrhage resulting in Wernicke's aphasia.