A 62-year-old man experienced a temporary episode of aphasia while giving a speech, as well as previous episodes of double vision. He had undergone mitral valve replacement two years prior and was being treated with anticoagulants. The episodes were likely caused by small pieces of thrombus breaking off from his prosthetic heart valve and blocking blood flow to parts of his brain (TIAs). Insufficient anticoagulation treatment likely led to the formation of the thrombi. The aphasia was caused by disruption of blood flow to the language processing areas of his left brain.

1. Group#: 5
Case 2, Week 3
Qussi J. Al-Rebh
TUESDAY 8/9/2016

2. Cerebrovascular disease!
• Cerebrovascular disease refers to a group of
conditions that affect the circulation of blood to
the brain, causing limited or no blood flow to
affected areas of the brain.
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Cerebrovascular
Blood flow in
your brain.
Vascular
which means
arteries and
veins.
Cerebro
large part of
the brain.

3. Case scenario
While giving a speech, a 62 – year – old man is suddenly unable
to find the right words. He also feels slightly faint. After about 5
minutes he can speak normally again and can also understand
everything that is said to him. He has never had a speech
disorder like this before; however, he has had two episodes of
double vision, lasting 5 and 15 minutes respectively, which
disappeared spontaneously. For the past two years he has been
treated with anticoagulants after the replacement of his mitral
valve.
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4. Learning Objectives
• What are these Episodes called and what
is the probable cause in this patient?
• How can the episodes of double vision be
explained?
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5. Mitral valve replacement:
• Cardio surgical procedure in which a
patient’s mitral valve is replaced by a prosthetic
valve.
• Performed when the:
• (mitral valve stenosis)
• (mitral valve regurgitation).
• Patients with these valves must
take anticoagulants for life. TUESDAY 8/9/2016

6. Anticoagulation drugs:
• Prevent blood clots from forming and growing
and reduce the risk for heart attack, stroke and
blockages in the arteries and veins
• Insufficient dosage of anticoagulant makes the
patient susceptible to embolic events
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7. Double vision (Diplopia):
• A condition where a single object is seen in
duplicate when the image produced by two eyes
don’t absolutely match.
• Caused by paralysis or loss of coordination of one or
more muscles that control the one eye movement
due to a cranial nerve palsy
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8. Diplopia:
• Normally, eye movement controlled by :
• The 3rd cranial nerve (oculomotor nerve)
• The 4th cranial nerve (trochlear nerve)
• The 6th cranial nerve (abducent nerve)
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9. Pathophysiology of diplopia:
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10. Aphasia:
• Aphasia is an impairment of language, affecting the
production or comprehension of speech and the
reading or writing could be affected.
• Aphasia is always due to injury to the brain ( head
trauma, brain tumors, or infections), most commonly
from a stroke
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11. Aphasia:
• In general, the left hemisphere of the
brain is responsible for language and speech
and is called the "dominant" hemisphere
• Cause by Damage of Broca’s area or
Wernicke's area or both.
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12. Aphasia:
• The type of aphasia depends on the brain area
affected:
• Broca’s area lies in the left frontal lobe.
• Blood supply : Middle Cerebral Arteries.
• If this area is damaged, It called Broca's aphasia
• Causes reduced speech fluency with inability to
understand what he is saying.
• The patient makes great efforts to initiate language,
which becomes reduced to a few disjointed words
with failure to construct sentences TUESDAY 8/9/2016

13. Aphasia:
• Wernicke's area lies in the left temporal lobe .
• Blood supply : Middle Cerebral Arteries
• Damage to this area causes Wernicke's
aphasia.
• The individual may speak in long sentences
that have no meaning, add unnecessary words,
and even create new words.
• They can make speech sounds, however they
have difficulty understanding speech and are
therefore unaware of their mistakes. TUESDAY 8/9/2016

14. Aphasia:
• Global (central) aphasia:
• The combination of Broca’s comprehension of
Wernicke’s with loss of both language
production and understanding.
• aphasia and the loss of This is due to
widespread damage to speech areas
• And is the commonest aphasia
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15. Aphasia Pathophysiology:
• Due to mitral valve replacement and
insufficient anticoagulation, Piece of thrombus on the
surface of prosthetic valve broke off
•The resulting embolus probable passed
readily through the internal carotid artery
Disruption blood supply in the cerebral area of
speech Ischemia.
•Affect speech area Aphasia
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16. what is TIA?
•A transient ischemic attack (TIA) — also called a
ministroke: A temporary decrease in blood supply to
part of your brain causes TIAs, which often last less
than five minutes.
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17. Signs and Symptoms?!
•Stroke symptoms depend on the affected area of the
brain.
•The main symptoms are “the FAST” symptoms:
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18. Risk Factors
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High blood
pressure

19. TIA Treatment :
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Anticlotting drug
antihypertensive
therapyinternal carotid
endarterectomy
Rehabilitation

20. Complications ?!
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ParalysisEmotional problems
Difficulty talking
central pain syndrome
Memory loss

21. summary
• When the single object duplicated, we call it diplopia.
• Inability to find the right words or to talk called
aphasia.
• Which has 3types: Broca’s aphasia, Wernicke aphasia, and
global apasia.
• TIA is a temporary decrease in the blood supply in the
brain.
• One of the main causes of TIA in the heart patients is
insufficient using of anticoagulation drugs.
• The signs and symptoms are “FACT symptoms”. TUESDAY 8/9/2016

22. References
• http://www.medicalnewstoday.com/articles/184601.php
• http://www.aans.org/Patient%20Information/Conditions%20and%20Tr
eatments/Cerebrovascular%20Disease.aspx
• http://www.stroke.org/site/PageServer?pagename=stroke
• http://www.nhlbi.nih.gov/health/health-
topics/topics/stroke/signs.html
• http://www.medicinenet.com/stroke_symptoms_and_treatment/page
6.htm
• http://www.mayoclinic.org/diseasesconditions/stroke/basics/definiti
on/con-20042884
• http://www.uptodate.com/contents/stroke-symptoms-and-
diagnosis-beyond-the-basics
• http://www.nhsggc.org.uk/content/default.asp?page=s1418_1_1
• http://en.wikipedia.org/wiki/Hypoglycemia
• Clinical medicine chapter 22 TUESDAY 8/9/2016

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