The thing of which she could not speak: transient biopercular syndrome as a very late complication of unsuccessful chemical abortion

Abstract

A 40-year-old schoolteacher with no medical history developed a left hemicranial headache accompanied with vertigo, followed by anarthria, sialorrhea, and paresthesias in both cheeks and in the tip of the tongue. The symptoms lasted approximately half an hour. When she consulted the next morning, she only presented with a slight left central facial paresis and a hypoesthesia that resolved in the following days. Fluid attenuated inversion recovery sequences of a magnetic resonance imaging (MRI) showed a corticosubcortical hypersignal, interpreted as gliosis, of the posterior part of the left frontal lobe and the right prerolandic region, on both sides extending into the insula, but sparing the most superficial cortical layers and mild local cortical atrophy (Fig. 1a, b). There were no hemosiderin deposits on T2 gradient sequences or signs of gadolinium uptake. Technetium 99-m single photon emission computed tomography showed a disruption of cortical activity in both opercular regions (Fig. 1c). Electroencephalography (on day 1) and blood analysis including basic metabolic panel, C-reactive protein, liver and thyroid function, antinuclear antibodies and anticoagulation tests were normal. There was no serological evidence for a bacterial, viral or parasitic infection and routine cerebrospinal fluid analysis was normal. Formal neuropsychological testing was normal. Given the absence of persisting clinical signs compared to the extension and the chronic character of the lesions, the biopercular syndrome might be attributed to an epileptic decompensation of otherwise silent perinatal brain injuries. Initially, there was no history of perinatal complications, but later on, the patient’s mother confessed that she had undergone an attempt of a chemical abortion. Eight years later and without treatment, the patient is still symptom free.