Differential Diagnosis for the Presented Case
The patient presents with confusion, difficulty following complex instructions, and impaired language comprehension and expression. Based on the symptoms, the following differential diagnoses are considered:
- Single most likely diagnosis
- b) Aphasie d’expression: The patient's language is ralenti (slow) but lucide (clear), indicating a possible expressive aphasia. The difficulty in following complex instructions and impaired comprehension of multi-step commands also support this diagnosis.
- Other Likely diagnoses
- c) Aphasie mixte: Although the patient's language is described as lucide, the presence of both expressive and receptive language deficits (e.g., difficulty following instructions, impaired object identification) could suggest a mixed aphasia.
- d) Apraxie verbale: The patient's slow and effortful speech, as well as difficulty with complex instructions, might be indicative of apraxia of speech, which is a type of speech disorder characterized by difficulty with the muscular movements necessary for speaking.
- Do Not Miss
- Hypoglycémie ou hyperglycémie sévère: Given the patient's history of diabetes (Db2), it is essential to rule out severe hypoglycemia or hyperglycemia, which can cause confusion, altered mental status, and language disturbances.
- Accident vasculaire cérébral (AVC): A stroke can cause sudden onset of language disturbances, including aphasia, and is a critical diagnosis to consider, especially in a patient with a history of hypertension (HTA) and obesity.
- Rare diagnoses
- a) Dysarthrie cérébelleuse: Although dysarthria can cause speech difficulties, the patient's symptoms are more suggestive of a language disorder rather than a pure speech disorder. Cerebellar dysarthria is a rare condition that typically presents with ataxic speech, which is not explicitly described in the case.