Question

Mr. T presents to the Emergency Department (ED) with right sided weakness, slurred speech, and bruising on his right side from falling when he tried to get out of a chair. His wife states that he had experienced the same symptoms a month ago, but they resolved in a few hours so they did not think too much about it. You explain to the patient that what he experienced a month ago was a TIA.

1. Describe a transient ischemic attack (TIA) including why the signs and symptoms resolve completely.

2. Discuss the difference between a cerebral infarction and cerebral hemorrhage including clinical manifestations.

Mr. T was admitted to the stroke unit. Once there they began a detailed evaluation and determined that he was also experiencing agnosia. His wife would like to know what this is.

3. How would you respond to this question?

4. How does agnosia differ from expressive and receptive dysphasia and acute confusional states?

Answer 1

1.  TIA is a temporary blockage of blood flow to the brain. ... TIAs are often labeled "mini-strokes," because they can be relatively benign in terms of immediate consequences. ... The symptoms are similar to an ischemic stroke, but TIA symptoms usually last less than few minutes to 1 or 2 hours. The blockage causing TIA getting pushed "downstream" or may be broken up by natural clot dissolves ( anti coagulants) of the blood. So blockage not remain in place for long To cause any lasting damage to brain. Tha patient Mr. T had experienced the same a month ago.

2. cerebral infarction is an area of necrotic tissue in the brain resulting from a blockage or narrowing in the arteries supplying blood and oxygen to the brain. .The restricted oxygendue to the restricted blood supply causes an ischemic stroke that can result in an infarction if the blood flow is not restored within a relatively short period of time. The blockage can be due to a thrombus, an embolus or an atheromatous stenosis of one or more arteries.Symptoms of cerebral infarction are determined by the parts of the brain affected. If the infarct is located in primary motor cortex, contralateral hemiparesis is said to occur. Infarctions will result in weakness and loss of sensation on the opposite side of the body. Physical examination of the head area will reveal abnormal pupil dilation, light reactionand lack of eye movement on opposite side. If the infarction occurs on the left side brain, speech will be slurred. Reflexes may be aggravated as well.

Cerebral hemorrhage or Intracerebral hemorrhage (ICH), also known as cerebral bleed, is a type of intracranial bleed that occurs within the brain tissue or ventricles. ... In many cases bleeding is present in both the brain tissue and the ventricles. Causes include brain trauma, aneurysms, arteriovenous malformations, and brain tumors. . Many people who experience a brain hemorrhage have symptoms as though they are having a stroke, and can develop weakness on one side of their body, difficulty speaking, or a sense of numbness.

3. Agnosia is an inability to recognize sensory inputs such as light, sound, and touch). Agnosia is typically a result of brain injury. For example, damaging the back part of the brain can cause visual agnosia (inability to properly recognize objects by sight).  It is usually associated with brain injury or neurological illness, particularly after damage to the occipitotemporal border, which is part of the ventral stream. Agnosia only affects a single modality, such as vision or hearing. More recently, a top-down interruption is considered to cause the disturbance of handling perceptual information.

4. Dysphasia is one of the group of speech disorders in which there is impairment of the power of expression by speech, writing, or signs, or impairment of the power of comprehension of spoken or written language.  The symptoms of dysphasia vary based on the region of the brain that was damaged. There are different regions responsible for understanding language, speaking, reading, and writing, though typically they are found in the left side of the brain.

People with receptive dysphasia have difficulties comprehending or receiving language. Imagine this form of dysphasia as feeling like people are always speaking to you in a foreign language. Sometimes it can be easier to break sentences down into short, simple segments to prevent overwhelming the person with dysphasia, and it can also help to communicate in places without background noise or distractions. A person with receptive dysphasia may also have trouble reading out loud, whether the material was written by them or someone else, and they may forget information quickly.

People with expressive dysphasia have trouble expressing themselves in words. Some people with this form of dysphasia may not be able to verbally speak or communicate at all. Or, if they can speak, they may have trouble finding the right word they want to use or may accidentally use the opposite word of the one they're looking for, or may not make sense at all, but not realize it. In addition to verbal communication, they may also struggle with reading and writing. Imagine having clear thoughts that you can't effectively communicate to the outside world. In many cases, this is what having expressive dysphasia feels like.

Acute confusional state, also known as delirium, is an organically caused decline from previously baseline level of mental function. It often has a fluctuating course, attentional deficits, and disorganization of behavior. Delirium itself is not a disease, but rather a set of symptoms.

Whereas agnosia is an inability to recognize sensory inputs such as light, sound, and touch). Agnosia is typically a result of brain injury. For example, damaging the back part of the brain can cause visual agnosia (inability to properly recognize objects by sight).  It is usually associated with brain injury or neurological illness, particularly after damage to the occipitotemporal border, which is part of the ventral stream.