APHASIA, APRAXIA, AND AGNOSIA

Ask the following questions:

1. Is it intermittent? Episodic aphasia, apraxia, or agnosia would suggest epilepsy, transient ischemic attacks, migraine, or hypertensive encephalopathy.
2. Is it acute or gradual in onset? Acute onset of aphasia, apraxia, or agnosia would suggest a cerebral vascular accident, or if there is fever, the onset of a cerebral abscess. It may also mark the onset of acute encephalitis. The gradual onset of aphasia, apraxia, and agnosia would suggest a tumor or other type of space-occupying lesion.
3. Is there associated headache or papilledema? Headaches with aphasia, apraxia, and agnosia might suggest migraine, but one should not forget a brain tumor. Obviously, papilledema is a sign of a space-occupying lesion.
4. Is there significant dementia? The development of dementia along with the aphasia, apraxia, and agnosia suggest Alzheimer's disease, Pick's disease, herpes encephalitis, multiple sclerosis, or Korsakoff's psychosis.

DIAGNOSTIC WORKUP

All patients should have a CBC, sedimentation rate, chemistry panel, a VDRL test, and a CT scan of the brain. The CT scan may demonstrate an infarct, a space-occupying lesion, a degenerative disease, or multiple sclerosis. If this is negative, a neurologist should be consulted before ordering MRI or a spinal tap.

If the patient presents with intermittent aphasia, apraxia, or agnosia, an EEG should be done to rule out epilepsy, and a carotid scan should be done to rule out carotid stenosis or carotid plaques with ulceration. Four-vessel angiography may need to be considered, but a neurologist should be consulted before this is done.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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