Aphasia imitating an acute ischaemic cerebrovascular attack in the Neurology Department of the Hospital de San José Bogotá DC

Crisis afásica simulando un ataque cerebrovascular isquémico agudo en el Servicio de Neurología del Hospital de San José de Bogotá DC

Ictal or post-ictal aphasia has been demonstrated in almost 17% of patients. In some cases in which it is the only ictal symptom, as in the epileptic aphasic status, it could represent a diagnostic challenge, and depend on the level of clinical suspicion. A case is presented of an elderly adult who arrived in the emergency room with a speech impairment. It was first suspected as an ischaemic cerebrovascular attack, but the video telemetry, requested after evaluating the magnetic resonance image, showed lateralised epileptiform discharges in the left temporal region, for which the patient was managed as an aphasic status with subsequent improvement.

1. Toledo M, Munuera J, Sueiras M, Rovira R, Alvarez-Sabín J, Rovira A. MRI findings in aphasic status epilepticus. Epilepsia. 2008;49:1465–9.

2. Chung PW, Seo DW, Kwon JC, Kim H, Na DL. Nonconvulsive status epilepticus presenting as a subacute progressive aphasia. Seizure. 2002;11:449–54.

3. Toledano R, Jiménez-Huete A, García-Morales I, Campo P, Poch C, Strange BA, et al. Aphasic seizures in patients with temporopolar and anterior temporobasal lesions: A video-EEG study. Epilepsy Behav. 2013;29:172–7.

4. Sadiq SB, Hussain SA, Norton JW. Ictal aphasia: An unusual presentation of temporal lobe seizures. Epilepsy Behav. 2012;23:500–2.

5. Loddenkemper T, Kotagal P. Lateralizing signs during seizures in focal epilepsy. Epilepsy Behav. 2005;7:1–17.

6. Abou-Hamden A. Small temporal pole encephaloceles: A treatable cause of “lesion negative” temporal lobe epilepsy. Epilepsia. 2010;51:2199–202.

7. Ali F. The assessment of consciousness during partial seizures. Epilepsy Behav. 2012;23:98–102.

8. Ericson EJ, Gerard EE, Macken MP, Schuele SU. Aphasic status epilepticus: Electroclinical correlation. Epilepsia. 2011;52:1452–8.

9. Patel M, Bagary M, McCorry D. The management of Convulsive Refractory Status Epilepticus in adults in the UK: No consistency in practice and little access to continuous EEG monitoring. Seizure. 2015;24:33–7.

10. Asadi-Pooya AA, Jahromi MJ, Izadi S, Emami Y. Treatment of refractory generalized convulsive status epilepticus with enteral topiramate in resource limited settings. Seizure. 2015;24:114–7.

11. Rantsch K, Walter U, Wittstock M, Benecke R, Rösche J. Treatment and course of different subtypes of status epilepticus. Epilepsy Rese. 2013;107:156–62.

12. Al-Mufti F, Claassen J. Neurocritical care: Status epilepticus review. Crit Care Clin. 2014;30:751–64.