Transcortical Sensory Aphasia as a Result of Left Frontal Cortical-Subcortical Infarction

Abstract

She was reportedly studying Spanish as a second language. A full neurological workup and a detailed speech-language assessment were conducted. Neurological examination revealed a conscious alert lady with intact power in all 4 extremities, grade 5/5 (Medical Research Council grade) and down going plantars. There were no sensory deficits, and cortical sensations were intact. Visual fields could not be assessed reliably on account of the patient’s auditory comprehension deficits. Detailed language testing was carried out by a certified speech pathologist on day 3 of stroke. As a part of formal language testing with standardized aphasia batteries, 7 language tasks were administered during testing to assess for spontaneous speech, repetition, auditory comprehension, naming, word and paragraph reading and syllable discrimination. Language assessment revealed fluent verbal output in the presence of impaired auditory comprehension and intact repetition. Spontaneous speech was fluent and effortless. Auditory comprehension was impaired, and the patient had significant difficulty with single-step commands like ‘touch your nose’ or ‘close your eyes’. ReDear Sir, Transcortical sensory aphasia (TSA) typically localizes to the left parieto-occipital cortex and usually is due to an infarct in the inferior division of the left middle cerebral artery. We present here a case of a 75-year-old right-handed woman admitted to our hospital with acute onset of speech and language disturbance. When assessed, her spontaneous speech was fluent, and she had no difficulty in speech initiation and in her ability to repeat short sentences (6–7 words). She did have severe difficulty in visual recognition and aural comprehension of words and in her ability to name objects. Computed tomography (CT) and magnetic resonance imaging showed a left frontal cortical-subcortical infarct. The anatomical correlate of TSA is also discussed.