[A 52-year-old man with sensory aphasia and multiple intracranial masses]

We report a 52-year-old-man who developed aphasia, apraxia and agnosia. He was well until December of 1991 when he noted an onset of skin scaling in the extensor sides of his elbow joints; he was admitted to the dermatology service of our hospital and was diagnosed as having pemphigoid. Treatment with PDN 30 to 60 mg/day and azathioprine 50-100 mg was started. While in the hospital there was a insidious onset of right tinnitus and tingling sensation in his right leg in the middle of March, 1991. During next one week, his family noted that the patient responded incoherently in his speech once in a while. Neurological consult was requested on April 2, 1991. On neurologic examination, he was alert but incoherent in his speech. His spontaneous speech was reduced but it was fluent. However, he had a difficulty in understanding spoken as well as written language. Naming and repetition were also impaired, and he appeared to have Wernicke's aphasia. Ideational apraxia, ideomotor apraxia, constructional apraxia, left-right disorientation, finger agnosia, and body agnosia were noted as well, but he did not have dressing apraxia or spatial disorientation. Right homonymous hemianopsia was present, but any other cranial nerves were not disturbed. He had no weakness or ataxia; gait was normal. Deep reflexes were normal and symmetric. Sensations were intact. Complete blood counts and routine blood chemistries were normal. The lung was clear. Opening pressure at spinal tap of CSF was under a normal pressure; CSF contained 6 lymphocytes/microliters and 78mg/dl of protein; a cytological study showed no malignant cells.(ABSTRACT TRUNCATED AT 250 WORDS)