dr_sarim
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1. A 72-year-old woman depressive has problems finding the correct words. Her speech is effortful, and her sentences are very short. Her comprehension of spoken language is normal, but her comprehension of written language is reduced. In writing, she makes many spelling and grammar mistakes. She is disoriented to time. Where is the lesion responsible for her symptoms most likely located?
A
Left angular gyrus
B.
Left frontal lobe
C.
Left temporal lobe
D.
Right frontal lobe
E.
Right parietal lobe
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| robin082006
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A
GERSTMANN SYNDROME
IF YOU SUSPECT, YOU CAN DO THIS QUESTION BY EXCLUSION AND ONLY CHOICE A IS SUITABLE.
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| waqastariq
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I agree
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| dr_sarim
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this is the reasoning (from usmle step123)
Option B (Left frontal lobe) is correct. The patient suffers from "Broca’s aphasia." The cause is most likely a slow-growing tumor (meningioma), which gives pressure to the left frontal lobe, causing the aphasia and the organic psychosis (disorientation, depression).
Option A (Left angular gyrus) is incorrect. A lesion in this area causes abnormal writing (spelling errors) and abnormal comprehension of written language. Spoken language is usually not affected.
Option C (Left temporal lobe) is incorrect. A lesion in this area causes Wernicke’s aphasia. Patients use wrong and nonexistent words. Comprehension of language is impaired.
Option D (Right frontal lobe) is incorrect. The language centers are located in the dominant (left) hemisphere.
Option E (Right parietal lobe) is incorrect. The language centers are located in the dominant (left) hemisphere.
BROCA'S APHASIA
Perhaps the most obvious symptom of Broca's Aphasia is effortful, non fluent speech. This speech is characterized as having many pauses, few words, and short sentences.
In addition to having impaired speech, people with Broca's aphasia also have difficulties with writing. Writing is included in expressive language, which is why damage to Broca's Area of the brain would affect it. aural comprehension for conversational speech is relatively intact.
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| Dr.Papez
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B is right
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| robin082006
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How can we explain alexia and agraphia?
In Kaplan, non-fluent aphasia (Boca's aphasia) alexia, agraphia, and left-right disorientation-> Gerstmann syndrome
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| fox
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there is no mention of agraphia...is it there?
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| vallia
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this is kinda tricky question
but I go with Broca (area 44, 45) aphasia characterised by effortful speech with short sentenced. also depressed (in frontal lobe syndrome). Most of Broca goes with agraphia too.
In Gerstmannn's syndrome (lession in area 39) we have alexia, acalculia, finger agnosia, R-L disorientation, agraphia. the speech is not affected.
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| dr_sarim
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fox: there is no mention of agraphia...is it there?
well i guess they have mentioned dysgraphia rather then agraphia ...but doesnt matter
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| Dr.Papez
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Broca's aphasia patients do have reading and writing problems as well. Especially ... they will find ti difficult to read sentneces rich in grammer. for e.g. they can read headlines in anews paper better than the full story. They can read a telegram better than a snail post. (emial must be easier as well!). The same is true for writing...lot of spelling and grammatical errors.
To add to confusion, invariably all Broacas aphasia pts do have some sublte comprehensin impairment also...especially when you challenge them with complex sentences...multiple step commands...the severity of involvement is only relative.
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