A73-year-oldwomanwithahistoryofhypertensionandarecentstrokepresentedwithrecurrentnonsensicalspeechandvisualproblems.Onemonthprior,shehadbeendiagnosedwithastrokeaftersuddenonsetspeechandvisualdifficultiesthatresolvedafterafewhours.Thirteendaysbefore,shehadhadasecondepisodeofsimilarsymptoms.Shewasseeninourinstitutionafterafewhoursofsudden-onsetunintelligiblespeech.Hervitalsignswerewithinnormallimits.Shewasnotindistressbutappearedfrustrated.Hergeneralphysicalexaminationwasunremarkable.Shehadnocarotid,ophthalmic,orcranialbruits.Herneurologicexaminationwasnotableforfluentaphasiawithparaphasicerrorsandinabilitytoname,read,orwrite.Shealsohadrighthomonymoushemianopia,right-sidedsensoryloss,andgeneralizedbriskdeeptendonreflexes.Therestofherneurologicexaminationshowednoabnormalities.
73岁老龄女性，既往有高血压病史，近期出现脑卒中，表现为反复发作的无意义言语及视觉障碍。一个月前，她因突然起病的言语困难和视觉障碍，被诊断为脑卒中，几个小时后以上症状恢复。十三天前，她又出现了类似的症状，表现为突然出现说话不知所云，几个小时后至我院就诊。她的生命体征正常，没有痛苦面容，但情绪低落。一般体格检查无明显异常体征。未发现颈动脉、眼和颅内血管杂音。神经系统检查主要的阳性发现包括：伴有错语的流利性失语、不能命名、阅读和书写、右侧同向性偏盲、右侧肢体感觉减退及深反射活跃。余神经系统检查未见异常。
Whatisyourdifferentialdiagnosis?Whatdiagnosticmodalitieswouldyouusetoinvestigatethecauseofhersymptoms?
您的鉴别诊断是什么？您将用什么方法来明确诊断？
Thiswomanpresentedwithrecurrentacute-onsetfluentaphasia,righthomonymoushemianopia,andright-sidedsensoryloss.Thesefindingslocalizetothecortical/subcorticalareasinthelefttemporalandparietallobes.Inanelderlypatientwithahistoryofhypertension,anacuteischemicorhemorrhagicstrokeisthemostlikelydiagnosis.Otherdiagnosticpossibilitiesincludeinfections(e.g.,herpeticencephalitis,abscesses),inflammation(ademyelinatinglesion),primaryormetastaticbraintumors,toxic-metabolicabnormalities,mitochondrialdisorders,andseizures.Sherecovered
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