Study 4: John (Speak up!)

John is a 32-year-old right-handed man who was recently found sprawled on the back patio by his buddy, Fred. When he woke, he had a right facial droop, was dragging his right leg, and did not appear to understand anything said to him. After being rushed to the ER, the doctors diagnosed a dense right hemiparesis (weakness). Doctors also noticed that while his speech was rapid and fluent, he was quite unintelligible. He showed no stilting or slurring of speech, and his overall articulation was fine. John had absolutely no trouble getting words outthe problem was that once they were out, they made no sense!

During his neuropsychological assessment, his doctor asked him to repeat sentences such as "will you answer the telephone?" More often than not, he would answer the questions ("yes I will" or "no, it's on the ground") rather than repeat the sentence. His spontaneous speech was filled with neologisms (made-up words) and jargon. In fact, one of his doctors commented that John's speech was reminiscent of the "Jabberwocky" poem by Lewis Carroll (i.e., "Twas brillig, and the slithy toves ... Did gyre and gimble in the wabe").

John was unable to comprehend written text or write coherently (his written work read much like his spoken words sounded; fluent but empty). And for all intents and purposes, John seemed completely unaware of his condition.

Questions:

1. What condition or conditions (there may be more than one possibility) are being described in this case? Let us know why you think this is the case and provide one website that might justify your position.
2. What brain area or area(s) may be involved (be sure to consider which language functions are compromised too, and be specific as to which hemisphere)? How should they function normally?
3. What could be causing this dysfunction?
4. What do the patient's symptoms tell you about his/his language abilities and how they may be impaired?
5. Putting yourself in the role of a professional counselor or biological psychologist, what advice do you have for concerned family or friends regarding the management of their responses to/engagement with John?