Authors :
Presenting Author: Olivia Mattner, DO – Florida Atlantic University
Jessica Canosa, MD – Florida Atlantic University
Pooja Patel, MD – Marcus Neuroscience Institute, Baptist Health Boca Raton Regional Hospital; Charles E. Schmidt College of Medicine and Florida Atlantic University
Rationale:
Acute onset aphasia is most commonly caused by cerebral vascular disease; however, other etiologies must be considered. We present two rare cases of aphasia secondary to new onset seizure and migraine with aura respectively that were diagnosed with the utility of Electroencephalogram (EEG).
Aphasia is the impairment of comprehension or formulation of language secondary to injury of the language cortical center. Acute onset aphasia is most commonly cause by vascular disease. Other causes of aphasia include neurodegeneration, such as Alzheimer Disease; brain tumor; and traumatic brain injury. Aphasia can also present during the ictal or postictal state of a patient with seizures. However, patients with no history of seizure and presenting with isolated aphasia, this can cause diagnostic difficulties. Although the pathophysiology is not completely understood, aphasia has also been associated with an aura in migraine.
Methods: Case Study
Results:
Patient A is a 65-year-old female with liver cirrhosis and peripheral neuropathy and Patient B is a 58-year-old female with alcohol use disorder, gait ataxia, and thiamine deficiency. Both patients presented with acute onset aphasia. An MRI brain was performed which was unremarkable, effectively ruling out a cerebral vascular cause of their aphasia. Patient A’s EEG demonstrated multiple seizures with a buildup of sharply contoured alpha activity in the left temporal region. Patient A’s aphasia was found to be secondary to seizures; she was placed on antiseizure medication with great response. In contrast, Patient B’s EEG demonstrated continuous large amplitude delta activity over the left hemisphere. Along with the clinical presentation of unilateral left sided headache, Patient B was diagnosed with complex migraine with expressive aphasia.
Conclusions:
Although the most common cause of acute onset of aphasia is stroke, other etiologies such as seizure and migraine should be considered. If appropriate, EEG can be utilized to help make the correct diagnosis. Funding: None