The Man Who Forgot How To Use His Computer
|This 79 year old right-handed White Male presented to University Hospital with a chief complaint of inability to use his computer.|
The patient had been working at his computer all night; he took a break approximately 8 AM. At 9:30 AM he tried to resume, but he found that he did not know how to use his computer. He also was unable to play his guitar. When his symptoms failed to improve as the day wore on, he decided to come to the ER for evaluation.
On examination, he had several subtle problems with language. His ability to name both high and low frequency objects was impaired. His speech had an expressive aprosody; there was little variation in speech with emotion. He had echolalia. He could remember 3/3 objects immediately, but none (0/3) in 5 minutes. He could spell the word "WORLD" forwards, but not backwards. He was unable to identify his fingers correctly. He reported that an apple, peach, and pear were "fruits"; but that a table, chair, and bed were "just three objects". He was unable to adequately demonstrate how to use a toothbrush without using his finger as a prop.
There was a mild right lateral rectus paresis and a right homonymous hemianopsia. He ignored those that spoke to him from the right. There was only a mild right pronator drift and mild weakness of his right upper extremity. He had a Babinski sign on the right and decreased appreciation of light touch and pin-prick in his right hand.
A CT Scan showed a 3 cm X 4 cm hemorrhage in the left posterior parietal lobe with surrounding edema and minimal mass effect.