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Opinion Article | DOI: https://doi.org/10.31579/2690-1919/109
*Corresponding Author: Deepanjan Bhattacharya, Medical College, Resident Doctor Medical College Kolkata 88, College Street Kolkata – 700073.
Citation: Deepanjan Bhattacharya, Deepadyuti Bhattacharya. Sudden Onset Mutism in A Elderly Women. J Clinical Research and Reports, 5(2); DOI:10.31579/2690-1919/109
Copyright: © 2020 Deepanjan Bhattacharya. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 16 July 2020 | Accepted: 28 July 2020 | Published: 03 August 2020
Keywords: Broca’s area; cerebral artery stroke; echocardiogram; hypertensive
A 70 year old right-handed female was brought to the emergency in view of sudden onset inability to speak. She was a known hypertensive for past ten years on oral medications, with no other known co-morbidities.
On examination, she was hemodynamically stable with a blood pressure of 130/80 mm Hg.
Systemic examination was unremarkable; there was no focal neurological deficit except for impaired speech output, while comprehension and writing skills were intact.
Non-contrast computed tomogram of the brain showed a hypodensity in the left frontoparietal zone, corresponding to acute ischemic infarct of the Broca’s area [Fig 1]. Electrocardiogram showed normal sinus rhythm and echocardiogram showed structurally normal heart with no evidence of thrombus.
A 70 year old right-handed female was brought to the emergency in view of sudden onset inability to speak. She was a known hypertensive for past ten years on oral medications, with no other known co-morbidities.
On examination, she was hemodynamically stable with a blood pressure of 130/80 mm Hg.
Systemic examination was unremarkable; there was no focal neurological deficit except for impaired speech output, while comprehension and writing skills were intact.
Non-contrast computed tomogram of the brain showed a hypodensity in the left frontoparietal zone, corresponding to acute ischemic infarct of the Broca’s area [Fig 1]. Electrocardiogram showed normal sinus rhythm and echocardiogram showed structurally normal heart with no evidence of thrombus.
She was started on oral aspirin, clopidogrel and atorvastatin, and advised comprehensive rehabilitation. On followup, she slowly regained her ability to speak and regained complete expressive speech by two weeks.
Around one-third of acute middle cerebral artery stroke patients have associated aphasia, and is mostly attributed to cardioembolism rather than atherosclerosis [1]. Mohr et al classified isolated Broca’s aphasia as “little” where mutism rapidly improves to effortful articulation with little residual speech disturbance, and “big”, which is accompanied by hemiparesis and other neurological deficits [2].
Levine et al studied 34 patients with isolated Broca’s aphasia, out of whom 53% were cardioembolic secondary to atrial fibrillation, with a clear male preponderance [3].
In conclusion, isolated infarct of Broca’s area is a rare occurrence and should be suspected in all patients who present with mutism.
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