A case of child aphasia caused by otogenic subdural abscess

Abstract

A rare case of aphasia in a 5-year 10-month old girl was followed for 3 years from the onset. This girl developed intracramal complication of left otitis media in Dec 1967, until that time her speech development had been normal. Upon surgery, subdural abscess was found in the region where the temporal, parietal and occipital lobe in the left hemisphere joined together. Incision yielded 17ml of yellow pus.On the 10 th postoperative day, speech disturbance was found. Remarkable decrement of verbal output, which was first noticed, lasted for 10 days. About a month postoperatively, hypofunction in all modalities of speech and language, word finding difficulty and disability of repetition were conspicuous. Neurological examination showed exaggerated reflex and incoordination of the right upper limb. EEG revealed abnormal pattern, but with no positive finding of focal brain damage.Intelligence score in“performance”test was within normal, in contrast with low score in“verbal”test. She showed no significant change either in emotional or behavioral aspects.Follow-up study of 12 months revealed that her daily conversation was apparently indistinguishable from those of her friends in kindergarten. However, systematic examination showed following abnormalities: 1) markedly decreased level of general ability in speech modalities, 2) correct repetition was feasible only in relatively short sentences, with some phonemic errors and omission or substitution of words, 3) word finding difficulty in naming familiar objects remained 60% level.In the 10 th postoperative month, she returned to the kindergarten, and on the 16 th month, went to elementary school. During above course, she had maladaptation. Quick understandings of her teacher's instructions were occasionally difficult. She spoke scantily. As she became senior, her school record became worse, especially in language and civics.