Symptom Finder - Aphasia, Apraxia or Agnosia
APHASIA, APRAXIA, AND AGNOSIA
These disorders signify a dysfunction of the cerebrum. Aphasia must be distinguished from dysarthria, which could also be due to involvement of the brain stem or cerebellum. Patients with dysarthria have no difficulty recognizing or interpreting words or phrases, but speech is garbled and difficult to understand by the clinician. The mnemonic VINDICATE would be useful in developing the differential diagnosis of these symptoms
and signs.
V—Vascular should bring to mind TIA, cerebral thrombosis, embolism, hemorrhage. Cerebral or arteriosclerosis should also be considered.
I—Inflammation conditions include viral encephalitis, brain abscess, and human immunodeficiency virus (HIV) infections.
N—Neoplasm brings to mind primary and metastatic tumors.
D—Degenerative disorders include Alzheimer disease, Pick disease,
Huntington chorea, and dementia with Lewy bodies. There is also a
condition known as progressive aphasia without dementia.
I—Intoxication should suggest the possibility of alcohol or drug intoxication and Korsakoff psychosis.
C—Congenital disorders include cerebral palsy, the leukodystrophies, and congenital abnormalities of the brain such as hydrocephalus and microcephaly. Cerebral aneurysm and atrioventricular (A-V) anomalies might also be brought to mind in this category.
A—Autoimmune disorders include multiple sclerosis, lupus erythematosus, thrombotic thrombocytopenic purpura, and other collagen disorders.
T—Trauma should bring to mind epidural, subdural, and intracerebral hematomas related to trauma.
E—Endocrine disorders are not particularly suggestive of cerebral pathology, but an amniotic fluid embolism may rarely be responsible for aphasia, apraxia, or agnosia. Hypoparathyroidism may bring about seizures which could cause transient aphasia in the postictal phase.
Approach to the Diagnosis
A thorough neurologic examination may disclose hemiparesis suggesting a cerebrovascular accident or papilledema suggesting a space-occupying lesion. The history would be very important in ruling out alcohol or drug intoxication, trauma, or autoimmune disorders. A CT scan would be useful in acute cases, whereas an MRI would be best for cases with a gradual onset. These studies would be most definitive for an infarct, space occupying lesion, or degenerative disorders. A VDRL test, ANA, CBC, and sedimentation rate would be helpful to rule out systemic causes. A urine drug screen may be necessary. For cases of intermittent symptoms, an EEG should be done to rule out epilepsy, and a carotid scan should be done to rule out carotid stenosis or plaque formation. A neurologist should be consulted if four-vessel angiography is contemplated.
These disorders signify a dysfunction of the cerebrum. Aphasia must be distinguished from dysarthria, which could also be due to involvement of the brain stem or cerebellum. Patients with dysarthria have no difficulty recognizing or interpreting words or phrases, but speech is garbled and difficult to understand by the clinician. The mnemonic VINDICATE would be useful in developing the differential diagnosis of these symptoms
and signs.
V—Vascular should bring to mind TIA, cerebral thrombosis, embolism, hemorrhage. Cerebral or arteriosclerosis should also be considered.
I—Inflammation conditions include viral encephalitis, brain abscess, and human immunodeficiency virus (HIV) infections.
N—Neoplasm brings to mind primary and metastatic tumors.
D—Degenerative disorders include Alzheimer disease, Pick disease,
Huntington chorea, and dementia with Lewy bodies. There is also a
condition known as progressive aphasia without dementia.
I—Intoxication should suggest the possibility of alcohol or drug intoxication and Korsakoff psychosis.
C—Congenital disorders include cerebral palsy, the leukodystrophies, and congenital abnormalities of the brain such as hydrocephalus and microcephaly. Cerebral aneurysm and atrioventricular (A-V) anomalies might also be brought to mind in this category.
A—Autoimmune disorders include multiple sclerosis, lupus erythematosus, thrombotic thrombocytopenic purpura, and other collagen disorders.
T—Trauma should bring to mind epidural, subdural, and intracerebral hematomas related to trauma.
E—Endocrine disorders are not particularly suggestive of cerebral pathology, but an amniotic fluid embolism may rarely be responsible for aphasia, apraxia, or agnosia. Hypoparathyroidism may bring about seizures which could cause transient aphasia in the postictal phase.
Approach to the Diagnosis
A thorough neurologic examination may disclose hemiparesis suggesting a cerebrovascular accident or papilledema suggesting a space-occupying lesion. The history would be very important in ruling out alcohol or drug intoxication, trauma, or autoimmune disorders. A CT scan would be useful in acute cases, whereas an MRI would be best for cases with a gradual onset. These studies would be most definitive for an infarct, space occupying lesion, or degenerative disorders. A VDRL test, ANA, CBC, and sedimentation rate would be helpful to rule out systemic causes. A urine drug screen may be necessary. For cases of intermittent symptoms, an EEG should be done to rule out epilepsy, and a carotid scan should be done to rule out carotid stenosis or plaque formation. A neurologist should be consulted if four-vessel angiography is contemplated.