1451 - Position Dependent Bilingual Aphasia in a Post Left Middle Cerebral Artery Ischemic Stroke Patient: A Case Report

Case Diagnosis: Left Middle Cerebral Artery Ischemic Stroke

Case Description: Bilingual right-handed male (Native Spanish, Secondary English) developed sudden onset slurred speech and right-sided weakness. Admitted to an acute care facility with evidence of left middle cerebral artery (MCA) ischemic stroke. Carotid doppler showed right internal carotid artery (ICA) stenosis (56%) and left ICA stenosis (< 30%). Physical exam showed global aphasia and right hemiplegia. Then admitted to Inpatient Rehabilitation Facility (IRF), where global aphasia progressed to Broca’s aphasia with complete English communication. After 20 days from event, aphasia progressed to bilingual where he started to communicate in Spanish, only when at right lateral recumbent position. When supine, he returned to English-only speaking. Patient progressed to comprehend Spanish and English but persisted with bilingual aphasia, spoken language remained English when supine, Spanish when right lateral recumbent.

Discussions: After IRF, patient progressed from Global Aphasia to Bilingual Broca’s aphasia with improvement on oral motor skills (25%), comprehension (20%) and expression (10%) compared to admission baseline. Predominant English spoken language when supine and Spanish when lateral recumbent position persisted upon discharge. This case could represent a variant of Bilingual aphasia not grossly explored in literature, which can be related to perfusion changes upon body position. Body position could affect brain blood flow and influence cortical activation. In turn, this can result in in spoken language changes that if confirmed to influence aphasia, could be modified by therapy techniques to improve patient’s rehabilitation.

Conclusions: Positional dependent bilingual aphasia could be a sub-type of aphasia which can be related to perfusion changes and can have an impact on patient’s rehabilitation.