Step I HY neuroanatomy weird case study

[stronghold]

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There is a weird case in HY p161. Patient is 7 year old with articulating difficulty, hears words normally and understands their meaning. History of difficulty in breast feeding during infancy.

Findings: limited ability to produce speech, Groping for correct placement of tongue, omission of words in sentences, atypical facial expressions.

The dx is apraxia! I thought that it was broca's aphasia since the boy understand meaning but have difficulty in expression, also broca sometimes is associated with lower facial weakness that could explain his history of feeding problem.
I can not understand why the answer is apraxia. If it's apraxia, then it should be motor apraxia (facial), but wernicke's area that is affected in motor apraxia, while in the case the boy has no problem in understanding words meaning!

This book made me crazy!! It is saturated with info and took much time, too!

 

[image187]

There is a weird case in HY p161. Patient is 7 year old with articulating difficulty, hears words normally and understands their meaning. History of difficulty in breast feeding during infancy.

Findings: limited ability to produce speech, Groping for correct placement of tongue, omission of words in sentences, atypical facial expressions.

The dx is apraxia! I thought that it was broca's aphasia since the boy understand meaning but have difficulty in expression, also broca sometimes is associated with lower facial weakness that could explain his history of feeding problem.
I can not understand why the answer is apraxia. If it's apraxia, then it should be motor apraxia (facial), but wernicke's area that is affected in motor apraxia, while in the case the boy has no problem in understanding words meaning!

This book made me crazy!! It is saturated with info and took much time, too!

I don't see why apraxia isn't more obvious... It's a disorder of purposeful motor function which is pretty evident here. The boy is able to speak but has a hard time correctly articulating (speaking certain words or ideas) and carrying out voluntary activities like making facial expressions. The trouble with sucking in infancy should hint at the early and chronic course of this disease. The case also says nothing about facial weakness, which may be more typical of a person who had a stroke and is experiencing an aphasia. This is acute and more likely in older people (not 7), and also improves over the long term. These patients have a terribly hard time speaking not because of anything motor in particular but because they can't find the words to express their ideas (funny enough, they can sing very well without trouble). An expressive aphasia wouldnt necessarily cause a person to make atypical facial expressions. To me this case says "apraxia" all over it!

 

[glykon]

There is a weird case in HY p161. Patient is 7 year (I didn't find anything on expressive aphasia for this age group) old with articulating difficulty(=points to the problem if you read carefully), hears words normally and understands their meaning.(vs expressive aphasia where they have varying degrees of understanding according to Wiki.)
History of difficulty in breast feeding during infancy (Image187,could you please elaborate on this one and the atypical facial expressions?)

Findings: limited ability to produce speech, Groping for correct placement of tongue, (gives away the diagnosis) omission of words in sentences (also appears in expressive aphasia) atypical facial expressions.

Thanks for bringing it up. I had no idea such thing even existed, but it intrigued me so I looked it up on Wiki. Apparently it's not so easy to differentiate between the 2; however I identified a few factors that pointed to the Childhood apraxia of speech rather than expressive aphasia (please see them in bold in the presentation) with my opinions more colored.
Source:
http://en.wikipedia.org/wiki/Apraxia_of_speech#Childhood_apraxia_of_speech
http://en.wikipedia.org/wiki/Expressive_aphasia
I'm not saying this is the absolute best explanation/differentiation, so I'd like to hear more opinions on it, esp. for things I didn't find that clear cut.

 

[stronghold]

Thanks guys...
glykon: It seems I am not alone!