Current Topics in Immunology Series No. 9

Abstract

OBJECTIVE: To describe a case of cortical spreading depression (CSD) causing recurrent global aphasia after TBI with evacuation of an acute left frontal subdural hematoma. BACKGROUND: CSD has been associated with migraine, stroke, subarachnoid hemorrhage and TBI. It has also been associated with loss of brain ion homeostasis, changes in energy metabolism, and changes of cerebral blood flow. CSD is difficult to detect clinically due to its brief and focal pathology. To date a case of CSD causing aphasia has never been reported. DESIGN/METHODS: Case report/clinical, radiologic. RESULTS: A 70 year-old RH man presented with TBI and a left frontal subdural hematoma initially managed conservatively. Approximately three months later the hematoma was surgically evacuated. After surgery the patient returned to baseline with minimal right pronator drift. Ten days after surgery, the patient presented with episodes of recurrent aphasia without headache as well as a worsening right pronator drift during episodes. The episodes consisted of global aphasia lasting thirty minutes to five hours. EEG was negative for seizures during these episodes demonstrating breach rhythm and intermittent slowing. MRI/MRA showed no focal lesions and normal vasculature. Transcranial dopplers demonstrated normal velocities. CT Perfusion showed increased mean transit time and decreased cerebral blood flow with not focal area of decreased blood volume. Patients’ episodes increased in frequency to multiple times a day in the face of two antiepileptics. The patient was placed on oral Magnesium and Topamax which resulted in resolution of episodes. CONCLUSION: CSD can be difficult to detect due to its brief and focal pathology. EEG should be done to exclude seizure and MRI/MRA to exclude stroke. CSD should be considered with a focal deficit with brief episodes when all other tests are negative. Better knowledge of the pathophysiolgy of CSD and its possible manifestations may facilitate a better way to diagnose as well as treatment to prevent CSD from causing permanent damage. <b>Disclosure:</b> Dr. Grayson has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Patel has nothing to disclose. Dr. Forteza has nothing to disclose.