oa Crossed Aphasia without Hemiparesis in a Dextral: A Case Report

Aphasia, also known as language impairment, is a condition that affects the ability to express and understand language, as well as the ability to communicate. Crossed Aphasia in Dextral (CAD) is defined as aphasia after a right hemispheric stroke. Usually, aphasia is caused by a left-sided stroke in right-handed individuals. The prevalence of crossed aphasia in right-handed individuals is 0.38% to 3%. CAD is diagnosed when the following factors are present: aphasia, right-handed patient, no family h/o left-handedness, the structural integrity of the left hemisphere, and absence of brain damage in childhood. Another entity, Global Aphasia Without Hemiparesis (GAWH), is a rare stroke syndrome presenting with global aphasia without any weakness and occurs in the lesion of the left-sided peri-sylvian region.

A 56-year-old female with a known case of severe mitral stenosis with chronic AF on warfarin and not on regular medications was brought to our hospital as she had not communicated for the past day. On initial examination, the patient was conscious, globally aphasic, with left facial lag and no weakness of limbs. Her initial Computed Tomography (CT) brain scan was normal. She was not thrombolysed as she was out of the window. Brain Magnetic Resonance Imaging (MRI) showed right frontal, temporal, and parietal infarct in middle cerebral artery territory. She was treated conservatively with full-dose anticoagulation and, upon discharge, was started on oral anticoagulants. At the time of discharge, the patient was able to understand a few commands and was having echolalia with non-fluent speech. She was reviewed again at 3 months, and she had a full recovery of her speech.

CAD is a rare stroke syndrome with low prevalence. Even though all subtypes of aphasic syndromes are seen in CAD, Broca's aphasia is the common subtype, and men are affected commonly. Most patients also present with apraxia and visuospatial neglect. Our patient had all the criteria for the diagnosis of CAD and also had GAWH and showed rapid recovery. The cause of the disease in this patient was considered to be two different lesions involving language areas due to an embolism in her heart.

This case has been presented for its rarity due to the occurrence of both CAD and GAWH in the same patient in a right-sided infarct.