Aphasia 103Blair gesturally deferred to Celia, and she began. “Blair was returning from the bathroom one
morning when he said he felt strange. He looked confused and frightened.” Blair nodded and said
“Numb” while pointing to his right arm. “When I asked him what was wrong, he shook his head
and sat down at the kitchen table with a confused look on his face.” Blair nodded and said, “She
mumbled and my head hurt like hell.” Celia then explained that she drove him to the emergency
room, and he was promptly admitted to the hospital. She reviewed the radiology and neurology
reports clearly and concisely, and said that although it was too early for the radiology test to defini-
tively identify the area of brain damage, she suspected the thalamus or the tracts leading to and
from it. She noted that the vascular accident, or infarct, was likely a ruptured blood vessel and not
an occlusion, and then described Blair’s hypertension and the poor results of the medi cation used
to control it. Celia also reported her informal evaluation of Blair’s communication disorder. She
justified the diagnosis of acoustic agnosia based on Blair’s comprehension prob lems and the fact
that they occurred in only one ave nue of language; it was not a multimodality aphasia. The clini-
cian was impressed with Celia’s summary and suggested the need for a comprehensive professional
evaluation to confirm her impressions.
The evaluation was conducted in the diagnostic suite, where Celia watched from an observa-
tion room with a two- way mirror. Blair was very cooperative. The clinician deci ded to assess the
role of slow rise time and auditory fade in his auditory comprehension prob lems. He asked Blair
to “Point to the ceiling,” then “Hold up three fin gers,” and fi nally, “Touch your nose.” Blair was
having considerable difficulty following these commands. Sometimes he simply raised his hand;
at other times, he looked at the clinician with an exasperated expression on his face. To make the
commands more auditorially salient, the clinician emphasized the first word of the command, and
at other times the last one, by saying these words more loudly and clearly. Each time, Blair looked
at him quizzically and sometimes said, “What?” and “ Pardon?” At the end of the test, the clinician
wrote the directional commands on a 3 × 5-inch note card. Blair easily read them, followed them
perfectly, and then, as if delivering a punch line in a comedy skit, said: “Why didn’t you just ask me
to do that?” Appreciating the humor in his statement, he chuckled, and the clinician heard, from
the observation room, Celia’s spontaneous muff led laughter.
Case Study 5-5: A 49- Year- Old Man With Progressive Aphasia
Resulting From a Malignant Brain Tumor
You are no stranger to the hospital’s neurosurgical operating room. Several times you have
been allowed to “gown up” and observe an operation, thanks to your friendship with a neurosur-
geon and your allied health practitioner staff privileges. The patient has agreed in writing to your
presence, and you stand just beyond the operating table, careful not to touch anything or interfere
with the operation. The anesthesiologist has just sedated the patient.
The patient’s name is Louis DeRosa. He was recently diagnosed with a malignant brain tumor
after complaining of numbness in the thumb and index fin ger of his right hand. The neurosurgeon
knows that his speech and language will be compromised by the surgery, so you have met twice