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Introduction: The most common cause of sudden isolated and prolonged global aphasia is acute stroke, affecting the cortical or subcortical language network. However, an aphasic status epilepticus (ASE) has to be considered as a possible differential diagnosis in awake patients presenting with acute and prolonged language impairment. ASE is suggestive of a localized dysfunction of language processing in the dominant hemisphere. ASE is a rare phenomenon and few cases are reported in the current literature. In the differential diagnosis between ASE and stroke with aphasia, FDG-PET imaging could be used when EEG shows no clear evidence of epileptic activity. Case Presentation: We described a case of a 74 year-old woman who presented sudden onset of isolated and prolonged global aphasia; she suffered 5 months before of a left temporo-occipital hemorrhage and 20 days before a left hemispheric ischemic stroke. A new ischemic or hemorrhagic event was excluded by neuroimaging (CT and MRI, including DWI). Since several EEGs did not show ictal epileptic pattern, but only inter-ictal slow waves in the left temporal region, an FDG-PET was performed, resulting in two hypermetabolic areas in the left temporal and occipital lobes. The aphasia improved after anti-epileptic therapy. Discussion and Conclusion: In conclusion, this is a case of post-stroke ASE, in which the evidence of hypermetabolism on FDG-PET allowed a definite diagnosis of epilepsy, despite the non-ictal EEG pattern.
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Temporary disruption of the blood-brain barrier (BBB) after cerebral angiography is presumably caused by nonionic radiographic contrast medium (CM). We hereby report a case of 58-year-old woman who developed decreased mentality, global aphasia and aggravated right hemiparesis after cerebral angiography. Brain CT examination demonstrated gyriform enhancement throughout the left cerebral cortex and thalamus. MR diffusion did not reveal acute infarction. MR angiography did not show any stenosis, spasm or occlusion at the major cerebral vessels. Follow-up CT scan after 1 day did not show any gyriform enhancement. Worsened neurologic signs and symptoms were improved completely after 7 days. In the present study, disruption of the BBB with contrast medium after angiography seems to be the causative factor of transient neurologic deterioration.
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Femenino , Humanos , Persona de Mediana Edad , Angiografía , Afasia , Barrera Hematoencefálica , Encéfalo , Angiografía Cerebral , Corteza Cerebral , Constricción Patológica , Difusión , Estudios de Seguimiento , Infarto , Manifestaciones Neurológicas , Paresia , Espasmo , TálamoRESUMEN
Aphasia, result from damage of language-dominant area of the brain, usually accompanied hemiparesis due to proximity of language centers and motor control areas. So, global aphasia without hemiparesis is a rare stroke syndrome. We report a case of right handed man with language disturbance after stroke. He showed global aphasia without hemiparesis. We use diffusion tensor image tractography (DTT) for evaluation of global aphasia without hemiparesis. DTT demonstrated that preservation of the corticospinal tract. After speech therapy, he showed improvement of language profile on K-WAB.
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@#Objective To observe the speech outcome of global aphasia after treatment.Methods 2 cases with global aphasia were trained using the Schuell aphasic stimulation approach,promoting aphasics communication effectiveness(PACE) and functional communication therapy(FCT),and assessed with the Standard Aphasia Examination of Chinese.Results Both patients showed obvious improvement.Conclusion The features of global aphasia can become as something of motor aphasia after speech training for several months or years.
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Global aphasia without other focal neurologic lateralizing signs (GWLS) is an uncommon stroke syndrome. The pathogenesis of GWLS has been thought as the result of multiple cardioembolism. However, a few cases of GWLS with a single lesion have been reported. We report an unusual case of GWLS with a single left superior temporal infarction. A 73-year-old right handed man was admitted with receptive and expressive language impairment without other focal neurologic lateralizing signs. The patient's global aphasia symptom has being 4 weeks after symptom onset. Brain CT showed only one lesion of left superior temporal lobe. Our case notes that the multiple lesions of the speech area are not only necessary to produce GWLS, and it is not necessarily imply a double lesion or an embolic causes.