case: Need Help

[Reborn24]

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Symptoms:
Headache(blurriness of vision, difficulty with balance)
Problems with naming, perseverance, and paraphasic errors
Decreased Plantar Reflex and Muscle Bulk



Im thinking of Broca's aphasia due to hemorrhage. However,the decreased plantar reflex makes me think that's it's not a vascular problem, but a neurologic disease. what do you think

 

[Nerdoscience]

On a technical note, the plantar reflex is not generally called decreased. It is either down-going, up-going, absent, or indeterminate. Down-going and absent are within the range of normal, as would be indeterminate (such as when you are checking a Babinski and the pt withdraws). Only up-going really tells you anything, and that points to upper motor neuron damage.

Decreased muscle bulk can happen with any long-term weakness regardless of cause, but if it is acute, there is probably a loss of muscle tone, which points to a lower motor neuron process (including the neuromuscular junction and the muscle itself).

As for the language findings, these are consistent with a few aphasia syndromes, including Broca's. The most typical cause of Broca's is an ischemic stroke, but it can be caused by anything that affects that region. It would be weird for that area of the brain to be affected without also affecting the motor strip and surrounding areas.

So, essentially, you've named something vague that could be intracranial (headache, vision change, balance problems), something that pretty much has to be intracranial (motor aphasia), and something vague that sounds non-specifically peripheral. Without more information (time course, location of weakness and abnormal reflexes, description of headache), it would be hard to place these things together.

 

[Reborn24]

She's been off and on for several months but have become more frequent lately with at least a low-grade headache being present most of the time. She is also very thin. 22 year old. No history of heart problems

 

[PublicHealth]

Symptoms:
Headache(blurriness of vision, difficulty with balance)
Problems with naming, perseverance, and paraphasic errors
Decreased Plantar Reflex and Muscle Bulk



Im thinking of Broca's aphasia due to hemorrhage. However,the decreased plantar reflex makes me think that's it's not a vascular problem, but a neurologic disease. what do you think

Scans?

 

[Nerdoscience]

1. What is the distribution of the muscle mass loss?
2. What has been off and on? The headache? The vision change? The muscle mass? The language deficit?