Document Detail

Bilingual aphasia due to spontaneous acute subdural haematoma from a ruptured intracranial infectious aneurysm.
MedLine Citation:
PMID:  18599195     Owner:  NLM     Status:  MEDLINE    
We report a case of spontaneous subdural haematoma due to ruptured intracranial infectious aneurysm, presenting with bilingual aphasia and illustrating differential language recovery. A 62-year-old right-handed bilingual gentleman, with a diagnosis of infective endocarditis, developed headache and became expressively aphasic in the English language. Three days later he was receptively and expressively aphasic in both English and Arabic. Cranial MRI scans showed a left-sided acute subdural haematoma with mass effect and midline shift. Contrast CT brain scans showed an enhancing speck adjacent to the clot and cerebral angiogram confirmed a distal middle cerebral artery aneurysm. He underwent image-guided craniotomy, evacuation of the subdural haematoma and excision of the aneurysm. Histopathological examination was consistent with an infectious intracranial aneurysm. Postoperatively his aphasia did not improve immediately. He had widened pulse pressure due to severe aortic regurgitation, confirmed on echocardiography. He underwent aortic valve replacement and mitral valve repair, following which his aphasia recovered gradually. Initially the recovery of his language was limited to Arabic. About a week later he recovered his English language as well. At 3-year follow-up he is doing well and has no neurological deficits. His aphasia has recovered completely. The present case is unique because of (a) presence of pure subdural haematoma, and (b) the differential susceptibility and recovery of native (L1) and acquired language (L2) in presence of a common pathology. The neurology of language in a bilingual is analysed and possible mechanisms discussed.
Girish V Vajramani; Hawar Akrawi; Rosaleen A McCarthy; William P Gray
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-07-02
Journal Detail:
Title:  Clinical neurology and neurosurgery     Volume:  110     ISSN:  0303-8467     ISO Abbreviation:  Clin Neurol Neurosurg     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-27     Completed Date:  2008-11-14     Revised Date:  2009-10-14    
Medline Journal Info:
Nlm Unique ID:  7502039     Medline TA:  Clin Neurol Neurosurg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  823-7     Citation Subset:  IM    
Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
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MeSH Terms
Aneurysm, Ruptured / complications*,  psychology*
Aphasia / etiology*,  psychology*,  surgery
Carotid Arteries / radiography
Central Nervous System Bacterial Infections / complications*
Cerebral Angiography
Hematoma, Subdural, Acute / complications*,  etiology,  psychology*
Intracranial Aneurysm / complications*,  psychology*
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Middle Aged
Neurosurgical Procedures
Tomography, X-Ray Computed

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