A case of isolated and prolonged global aphasia: ischemic stroke or aphasic status epilepticus.
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Date
2014-09
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Abstract
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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Keywords
Aphasic status epilepticus, global aphasia, ischemic stroke, FDG-PET
Citation
Giorli Elisa, Godani Massimilano, Beronio Alessandro, Ciarmiello Andrea, Cappellini Cesare, Sette Massimo Del. A case of isolated and prolonged global aphasia: ischemic stroke or aphasic status epilepticus. International Neuropsychiatric Disease Journal. 2014 Sept-Oct 2(5): 186-191.