Incoherent Speech Research Articles

Graphic Bodies: Picturing Feminised Pathology, Narrating Resistance

This article studies three graphic memoirs by women, Marisa Acocella Marchetto’s Cancer Vixen, Sarah Leavitt’s Tangles and Leah Hayes’ Not Funny Ha-Ha, to explore the use of the graphic form in the narrating of an experience of illness. I argue here that these writers engage the graphic form to visualise female embodiment as always already pathologised, even prior to the onset of illness. By making explicit the medical and socio-cultural scrutiny of female bodily practices, these texts interrogate the unequal structural relationship between the sign of gender female and the healthy/sick binary set up by mainstream illness narratives. This article also proposes that these graphic memoirs of illness by women perform a resistant femininity in narrative by refusing a linear progression from diagnosis to cure. The texts instead make visible their myriad sources, in the form of incoherent speech, unedited data, photographs and letters among others, thus refusing unity and coherence in the narrating self.

Postintervention acute opsoclonus myoclonus syndrome

Opsoclonus myoclonus syndrome (OMS) is a rare, neurological condition affecting 1 in 10 000 000 people annually. Opsoclonus, defined as involuntary rapid, multivectorial oscillations of the eyes, together with ataxia...

Ganser's syndrome: A nosographic approach

IntroductionGanser described a peculiar hysterical state, called Ganser's syndrome. This syndrome raises many etiological and psychopathological unresolved issues.ObjectivesThis article proposes to present the place of the Ganser's syndrome in the current nosographic framework throw the analyse of a clinical case and a literature review.ObservationA 28-year-old man was admitted for fugue and memory loss. This symptomatology evolves since three days after an emotional conflict.He complained from headache. He showed incoherent speech with approximate responses, lability, anxiety, auditory hallucinations, unstructured mild delusional ideation, cognitive difficulties, altered sleep-wake rhythm and anorexia.Memory gaps were observed with difficulties in abstract thinking.Symptoms totally regressed after one week under anxiolytic treatment.CommentsGanser's syndrome was evoked in the presence of suggestive symptoms: presence of a stressor factor, cardinal symptoms (approximate answers), associated symptoms (hallucinations + confusion + somatoform symptoms) and rapid restitution. Ganser considered this syndrome as a special case of crepuscular state, belonging to hysteria. Ganser's syndrome was included in DSM-III but located in factitious disorders against Ganser's position. In DSM-IV, it was positioned in unspecified dissociative disorders. In DSM-5, its place was reduced to a few words in the end of the introduction of dissociative disorders, and was no longer used as dissociative disorder.ConclusionAlthough Ganser's syndrome is not part of current diagnostic criteria for dissociative disorders, clinical descriptions of Ganser remain of clinical of interest by nosographic questions they have raised, in particular the link between simulation, psychiatric disorder and non psychiatric disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The effect of limited cognitive resources on communication disturbances in serious mental illness

Semantically incoherent speech is a pernicious clinical feature of serious mental illness (SMI). The precise mechanisms underlying this deficit remain unclear. Prior studies have found that arousal of negative emotion exaggerates the severity of these communication disturbances; this has been coined “affective reactivity”. Recent research suggests that “cognitive reactivity” may also occur, namely reflecting reduced “on-line” cognitive resources in SMI. We tested the hypothesis that communication disturbances manifest as a function of limited cognitive resources in SMI above and beyond that associated with state affectivity. We also investigated individual differences in symptoms, cognitive ability, and trait affect that may be related to cognitive reactivity. We compared individuals with SMI (n=52) to nonpsychiatric controls (n=27) on a behavioral-based coding of communication disturbances during separate baseline and experimentally-manipulated high cognitive-load dual tasks. Controlling for state affective reactivity, a significant interaction was observed such that communication disturbances decreased in the SMI group under high cognitive-load. Furthermore, a reduction in communication disturbances was related to lower trait and state positive affectivity in the SMI group. Contrary to our expectations, limited cognitive resources temporarily relieved language dysfunction. Implications, particularly with respect to interventions, are discussed.

Hybrid Approach to Single-Channel Speech Separation Based on Coherent–Incoherent Modulation Filtering

Single-channel speech separation is a challenging problem that has been of particular interest in recent years. Here the goal is to separate the target speech signal from the interference signals, with high accuracy. We propose a new hybrid single-channel speech separation system that applies adaptive coherent modulation filtering for low-frequency subbands and iterative incoherent speech separation technique for high-frequency subbands. In the adaptive coherent modulation filtering, an affine projection filter is applied to subband envelope in order to eliminate the interference signal. The subband envelope is determined via demodulation of the subband signal using a coherently detected subband carrier based on the time-dependent spectral center-of-gravity demodulation. The adaptive affine projection filter uses the separated target signal obtained from the iterative incoherent speech separation system as a reference signal. This system first obtains a rough estimate of target fundamental frequency range and then uses this estimate to segregate target speech. It then improves both fundamental frequency range estimation and voiced speech separation iteratively. Perceptual evaluation of speech quality, as one of the evaluation indices investigated in this paper, indicates that the proposed system extracts the majority of target speech segments with minimal interference and outperforms previous systems in voiced speech separation.

Acute Methiopropamine Intoxication After “Synthacaine” Consumption

Use of methiopropamine (MPA), a synthetic metamfetamine analog, has been detected since 2011 in Europe, but there is limited information on its acute toxicity. A 30-year-old man was admitted to the emergency department in a confused state, with paranoid delusion, auditory and visual hallucinatory experiences, and incoherent speech following the use of "synthacaine" (a slang term derived from "synthetic" and "cocaine"). Toxicological screening for pharmaceuticals and drugs of abuse by liquid chromatography-diode-array detector, gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry (LC-MS-MS) detected MPA, which was subsequently quantified by a specific LC-MS-MS method. Of note, 13 h after presentation to the emergency department, the plasma concentration of MPA was 14 ng/mL. This case report confirms the toxicity of MPA and the need for toxicological analysis to confirm the substance actually ingested by users of new psychoactive substances.

Subacute sclerosing panencephalitis still occurring in South Africa: Clinicians need to remain vigilant

To the Editor: We report on another child with subacute sclerosing panencephalitis (SSPE), expanding the case series reported by Kija et al. to six affected children from the Western Cape region of South Africa (SA) diagnosed in the past 18 months. The child presented to Red Cross War Memorial Children's Hospital, Cape Town, at 6 years and 3 months of age. She had recently returned to SA after living for several years in Zimbabwe. Her caregivers in SA had not seen her regularly, but understood that her previous health and development had been normal. She was admitted with a reported 1-day history of sudden onset weakness and abnormal movements. She had no known history of toxin exposure or prodromal symptoms prior to her presentation. She had neuro developmental regression and demonstrated emotional lability with incoherent speech and disorientation. She was not independently mobile.Her tone and power were normal and symmetrical with brisk deep tendon reflexes. Her abnormal movements were noted to be myoclonic jerks and atonic seizures which manifested as 'head nods'. She was systemically well with no evidence of sepsis, and while HIV-exposed she had tested negative. Cerebrospinal fluid (CSF) microscopy and chemistry results were normal. An electroencephalogram (EEG) was initially slow with no epilepti form activity correlating with the jerks. Owing to concern about her dramatic presentation and apparent acute-onset encephalopathy, an emergency magnetic resonance imaging (MRI) scan of the brain was performed. This showed high signal on T2 and fluid attenuation inversion recovery (FLAIR) in the posterosuperior putamina, seen to a greater extent on the left than the right (Fig. 1). On the basis of this finding and the unusual clinical phenotype, SSPE was suspected. The child's CSF measles IgG was positive, while CSF measles polymerase chain reaction (PCR) tested negative.

Acute psychosis in an adolescent with cerebral palsy

IntroductionCerebral Palsy is a movement, posture or muscle toning disorder caused by an insult to the immature, developing brain, most often before birth. It is a leading cause for serious disabilities in childhood and a risk factor for the development of psychiatric disorders, particularly in adolescents. Moreover, according to DSM-5, a Brief psychotic disorder is a short-term illness with psychotic symptoms, which arise suddenly, but last for less than one month, after which the person recovers completely.Objectives/AimsThe authors aim to present a case of an adolescent with cerebral palsy who has developed secondary psychotic symptoms, a rare and sparsely understood phenomenon.MethodsA non-systematic review of English scientific literature was conducted through research in the PubMed search engine, using the keywords “Cerebral Palsy” and “Brief Psychotic Disorder”.ResultsA 16-year-old female adolescent with history of Cerebral Palsy (due to neonatal anoxia) was admitted in the paediatric ward due to behaviour disorder characterized by incoherent speech, full insomnia, agitation and auto/alo-aggression. A complete clinical investigation was performed, in which trauma, organic brain injury, degenerative and inflammatory diseases, infection or toxic ingestion were all excluded. The hypothesis of an acute psychotic disorder was considered and after antipsychotic treatment, a total remission of the symptoms was obtained.ConclusionsAlthough rare, the association between cerebral palsy and psychotic disorders should be considered in the diagnostic investigation of behavioural changes. Early identification allows a proper therapeutic intervention and a better quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Ganser syndrome: Review and case report

IntroductionFirst described by Sigbert Ganser in 1987, Ganser syndrome consists in a rare condition, characterized by the following four clinical features: approximate answers, dulling of consciousness, conversion symptoms and hallucinations.ObjectivesTo present a case suggestive of Ganser Syndrome and to review the literature with particular regard to the aetiology of this condition.MethodsLiterature review, using computerized databases (MEDLINE®, Medscape®). Articles were selected based on the content of their abstract and their relevance.ResultsA 58-year-old woman was admitted to a Psychiatric Unit of a General Hospital for presenting behavioural abnormalities of acute onset. During hospitalization, the patient displayed indifference, incoherent speech with approximate answers, motor abnormalities and auditory psedudohallucinations. The patient was evaluated by a neurologist and various exams were performed (blood tests, CT, MRI, EEG) that showed no significant abnormalities. Pharmacological treatment consisted of antidepressant and antipsychotic medications. During the follow-up, there was a slow but gradual improvement of symptoms. Six months after hospitalization the patient decide to end up the follow-up.ConclusionsLittle is still known about Ganser Syndrome. The four aetiological perspectives consider: hysterical origin, malingering or factitious disorder, psychotic origin and organic origin. The lack of reports and information about Ganser syndrome made it worthwhile reporting this case.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Delirium related distress in family: A non-systematic review

IntroductionDelirium is a common neuropsychiatric syndrome, particularly in elderly hospitalized patients, and is associated with an increase in morbidity and mortality. Although these negative consequences are well documented, only a few studies describe the experience of delirium from the families’ perspective.AimsTo analyze studies regarding the experience and distress caused by delirium in the families/caregivers of adult/elderly hospitalized patients.MethodsA non-systematic review of published articles until October 2015 in the database PubMed was carried out. The keyword “Delirium” was combined with: “experience”, “distress”, “anxiety” and “family”, “carer” and “relatives”. Inclusion criteria were: standardized diagnosis of delirium, systematic/prospective assessment of distress level. Clinical cases were excluded.ResultsSixteen studies met the inclusion criteria for analysis. In most of them, family members (mostly younger) showed high levels of distress, even higher than health care professionals and patients. Several predictors of family distress were found, including poor functional status, psychomotor agitation, delusions, emotional lability, incoherent speech, inattention and disorientation. Higher distress was associated with long-term consequences (e.g. generalized anxiety). In the qualitative research, family members interpreted delirium as a sign of approaching death, result of pain/discomfort or an effect of medication. In addition, distress was associated with rapid and unexpected changes or unable to recognize the loved ones.ConclusionsDelirium in patients was associated with significant distress in family members. These findings underline the importance of providing information and the development of appropriate supportive and psychoeducational interventions in order to help families throughout this process and reduce the associated distress. This work is supported by FCT (SFRH/BPD/103306/2014).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Case series of Cyclogyl-induced delirium in elderly

Cyclopentolate is an anticholinergic, antimuscarinic tertiary amine which has been widely used as a topical cycloplegic and mydriatic agent by ophthalmologists. Systemic absorption of the drug can occur transconjunctivally or through nasolacrimal duct through highly vascular nasal mucosa. This can lead to central anticholinergic syndrome which includes restlessness, hallucination, psychosis, hyperactivity, seizures, incoherent speech, and ataxia. We report a case series of three patients developing central nervous system toxicity following instillation of cyclopentolate. This article lays stress on the judicious use of this drug and outlines the steps that can be taken to reduce systemic absorption and toxicity include using the lowest available concentration of the drug.

Nursing Staff Knowledge on Postoperative Delirium in Older Inpatients: An Exploratory Survey

Background/Objectives: Postoperative delirium is common in the elderly and is associated with poor outcome. However, its diagnosis is often missed or delayed. Nursing staff is at the frontline and plays a crucial role in the early detection and management of delirium. This study was designed to explore the knowledge and attitudes of nursing staff about delirium in the scope of an educational program implementation. Methods: Qualitative and quantitative analyses conducted in four surgical wards and one intensive care unit in an Academic Hospital in France. A questionnaire was administered to 171 nurses and nursing assistants and semistructured interviews were conducted. Results: A total of 89 questionnaires were completed (response rate of 52%). Regarding symptoms, most of the nursing staff knew about disorientation and incoherent speech. However, few knew about acute onset and fluctuation, and the hypoactive form of delirium was virtually unknown. Regarding risk factors, while many knew about dehydration, drug use and the use of physical restraints, few knew about fecaloma, sensory impairment and infection. The staff globally knew about the main prevention measures, but knowledge on patient management was especially poor. Finally, no respondent knew about or used the Confusion Assessment Method. The qualitative analysis revealed a trivialization of delirium onset among older inpatients and the continuity of preconceived ideas on delirium, its diagnosis and its risk factors. Conclusions: On the whole, this study provides a clearer understanding of staff learning needs and identifies potential issues to be addressed in order to increase future intervention efficacy.

Influenza-Associated Delirious Behavior

Dr Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Investigators from Japan retrospectively reviewed the medical records of children with influenza-associated delirious behavior (DB) to assess their clinical course.1 Children were eligible if they were admitted for treatment of rapid-antigen detection assay-confirmed influenza at the study hospital from 2009–2013, were diagnosed with DB, and had an MRI and EEG within 96 hours of DB onset. DB was defined as the presence of 1 or more of the following components: visual hallucinations, nonvisual sensory misperceptions, unexpected emotional changes, incoherent speech, purposeless …

A rare presentation of toxoplasma encephalitis in systemic lupus erythematous patient: case report and review of literature

We present a patient with systemic lupus erythematous (SLE) and visited emergency department, due to the progressive incoherent speech and disoriented to time in these few days. There were no obvious contact history or symptoms of infection. Due to the focal seizure, the brain magnetic resonance imaging (MRI) with gadolinium enhanced was arranged and revealed multiple ring enhancement picture and the brain abscess were suspected. The initial pathology suspected the lupus cerebritis, due to the vasculitis characteristic. Finally, according to the Immunohistochemistry study, the rare CNS infection of SLE patients– cerebral toxoplasmosis was confirmed the diagnosis.

EPA-1649 – Valproic acid induced encephalopathy associated with hyperammonemia: case report

Valproic acid is a broad-spectrum drug used in neurological disorders but also in psychiatric disorders such as mood stabilizer in bipolar or schizoaffective disorders. Despite being a usually well tolerated drug, valproic acid may be associated with some adverse effects. Most of which are mild and transient, however some adverse reactions may be serious like encephalopathy. In fact, valproic acid induced encephalopathy is an unusual but serious complication, characterized by decreasing level of consciousness, focal neurological deficits, cognitive slowing, vomiting, drowsiness and lethargy, with or without hyperammonemia. The aim of this work is to describe a case report of a woman who developed valproic acid induced encephalopathy during her hospitalization in the Coimbra's Psychiatric Department. This is a woman, 46 years old, diagnosed with a bipolar disorder who was hospitalized for stabilization of their depressive symptoms. At the entrance, a confusional state was found with fluctuating state of consciousness, psychomotor slowing and incoherent speech. An analytical study was conducted which showed a hyperammonemia of 70μg/ dL. Immediately the valproic acid was suspended on suspicion of encephalopathy induced by this drug. Gradually, in about 2 or 3 weeks, confusional state disappeared, and the patient discharged from the hospital oriented in time and space, with coherent speech, euthymic mood and regularized sleep. Valproic acid induced encephalopathy, is a reversible but potentially fatal adverse reaction that requires a high index of suspicion. Organic brain damage and polytherapy appear to be important risk factors for its occurrence.

EPA-1789 – Behind psychopathology - a corticobasal degeneration

Introduction The corticobasal degeneration (CBD) is a rare and severe neurodegenerative condition associated with a heterogeneous clinical syndrome of behavioral, motor, sensory and cognitive symptoms. Epilepsy is often associated with ictal, post-ictal and inter-ictal behavior changes, and it‘s a rare manifestation in DCB. Objectives/Aims Literature review on topic Corticobasal Degeneration, with presentation of a clinical case. Methods Research conducted in Pubmed with the words:’corticobasal degeneration’,’neuropsychiatric symptoms’. The clinical information was collected from patient and family. Results The authors report a case of a 55 years-old women with a history of anorexia nervosa, an affective disorder with features of Major Depression of 7 years of evolution and Epilepsy. Was admitted toInpatient Psychiatry Unit by rapidly progressive neurodegenerative clinical status of 6 months period, with temporo-spatial disorientation, incoherent speech, personality regression identifying substantial changes in behavioral pattern (apathy, depressed mood, anxiety), committing almost completely their autonomy. Neurological examination reported mnesic deficits, difficulty in memory recall, lack of ability to calculate and abstraction, ideational and ideomotor apraxia,’alien limb’ phenomenon, parkinsonism with global bradykinesia, gait in small steps and left hemibody stiffness. Emphasize the complementary diagnostic exams, the electroencephalographic study with bilateral paroxystic activity of central predominance and brain-MRI revealing leukoencephalopathy, Globus pallidus mineralization and cortico-subcortical atrophy. Conclusions The differential diagnosis of prion encephalopathy and limbic encephalitis were excluded, having performed therapeutic trial with methylprednisolone without improvements. It is discussed in this clinical case of DCB, the long pre-symptomatic period of pathological behavior and epilepsy, relative to rapidly progressive neurological deterioration.

EPA-1273 – When something relevant becomes an irrelevant - diagnostic labyrinth

Three methods are used to make a diagnosis: medical history, examination and laboratory-instrumental analysis. With advances in modern medical technology, laboratory instrumental analysis is gaining increasing importance and trust, while classical methods are neglected: a thorough review of the medical history and a detailed examination. To point out the significance of making a timely and correct diagnosis. Report the case of 47 year old female patient with no previous psychiatric history. Her symptoms appeared suddenly in the morning, developed a clinical picture with psychotic symptoms. A CT scan of her brain, was normal findings. She went to a neurologist, who produced an orderly neurological report and recommended a screening test for psychoactive substances (PAS). The test was positive for heroin, morphine and benzodiazepine. Since she is disoriented and has incoherent speech and neologisms, she was hospitalised at the Psychiatry hospital. Abuse of the PAS was excluded because she used analgesic contains codeine. On the seventh day of her stay a CT scan of her brain was made and showed a large ischaemic lesion in the left temporoparietal area. Laboratory-instrumental analysis is not without objective and subjective errors and must not guide the diagnosis without a sufficient clinical basis, and it must be preceded by a review of the medical history and an examination. A timely and correct diagnosis is important in order to provide adequate therapeutic treatment to a patient as soon as possible and in order to avoid needless hospitalisation in the psychiatry ward.

Varicella-zoster meningoencephalitis — Case report

Introduction: Encephalitis is defined as inflammation of the brain parenchyma and meningoencephalitis when there is meningeal involvement. A viral etiology is the most common and the diagnostic method of choice is the polymerase chain reaction (PCR) of viral nucleic acids in cerebrospinal fluid (CSF). Herpes simplex virus is the leading cause of encephalitis and varicella-zoster virus (VZV) a less common cause, particularly in immunocompetent individuals. Case report: Woman, 67 years old, retired nurse, brought to the emergency room by disorientation. Physical examination: slowed, disoriented, incoherent and repetitive speech; subfebrile (T-37, 2 °C); no meningeal signs or skin lesions were identified. Laboratory tests revealed leukocytosis (10.5 × 10 ^9/L) with neutrophilia (86.9%). Computed tomography and magnetic resonance imaging (MRI) of the brain were performed and there were no lesions on brain parenchyma. Lumbar puncture (LP): 5 leukocytes/mm3; erythrocytes 2327/mm3; glucose: 80 mg/dl, and protein 26.7 mg/dl. Blood, cerebrospinal fluid cultures and capsular antigens were collected. The patient had clinical worsening at 48 h with fever (T-38, 7 °C), agitation, seizures, left hemiparesis and meningeal signs. LP was repeated: leukocytes 40/mm (98% of polymorphonuclear cells), glucose: 113 mg/dl, and protein: 30.4 mg/dl. CSF cultures were repeated and viral PCR in cerebrospinal fluid was requested. Human immunodeficiency virus testing was negative. Empirically ceftriaxone, ampicillin and acyclovir 10 mg/Kg ev, 8/8 h was established. Electroencephalography revealed severe cortical structural damage in the left hemisphere. MRI of the brain was repeated and showed no lesions. Microbiological study was negative and VZV PCR in CSF was positive. She completed 21 days of acyclovir. The patient had a good clinical and neurologic outcome with resolution of all the symptoms. Conclusion: VZV meningoencephalitis. The case stands out for infection of the central nervous system by VZV in an immunocompetent patient, along with the importance of a high clinical suspicion of viral encephalitis even in the presence of pleocytosis with a predominance of polymorphonuclear cells in the early phase of infection. The suspicion of encephalitis is critical in the decision of early antiviral therapy to prevent neurological sequelae.

Neuropsychiatric complications in a patient with Marfan syndrome.

Marfan syndrome (MFS) is an autosomal dominant disorder of fibrillin-1 gene mutations, with the involvement of cardiovascular, skeletal, and ocular systems. In addition to physical abnormalities, MFS patients are also found to be susceptible to schizophrenia and other psychiatric conditions. Awareness of the association between MFS and psychiatric conditions would improve the clinical management of MFS patients to reduce the risk or even to prevent the development of psychiatric complications in MFS patients. Here, we describe a male MFS patient who manifested incoherent speech and impaired cognitive and social function at the age of 40 years. Results and conclusion His mental dysfunction could be attributed to his bilateral cerebral infarction, which is a neurovascular complication associated with MFS.

Lobar cerebral microbleeds associated with transient focal neurological symptoms followed by symptomatic intracerebral hemorrhage

Cerebral microbleeds (CMBs) are defined as all discrete round-shaped hypointense areas on T2*-weighted magnetic resonance images (MRIs) with a gradient-echo (GRE) sequence [11]. CMBs can be regarded as a marker of vessel wall disorders with a higher tendency for intracerebral hemorrhage (ICH) [11]. It has been suggested that microbleeds increase the risk of ICH following antithrombotic administration for acute ischemic stroke [9, 14], though this issue remains controversial. In addition, there have been few reports of symptomatic ICH that has occurred at the site of microbleeds in the literature [2, 13]. However, these lesions themselves have been considered asymptomatic. We present a case of CMBs presenting with transient neurologic symptoms that developed into subsequent ICH. A 65-year-old man with no previous neurological history visited our hospital because of incoherent speech and headache. He had a history of diabetes mellitus and chronic hepatitis B. He had been diagnosed with hepatocellular carcinoma prior to this presentation. Neurological examination revealed that he had language disturbances with jargon speech and abnormal comprehension. These symptoms fluctuated and persisted for about half an hour after symptom onset. The results of other physical examinations were normal. Electroencephalography showed that there were no epileptiform discharges or abnormal inherent rhythms. There were also no acute ischemic brain lesions or hemorrhages on initial brain MRI (Fig. 1a). GRE images showed multiple CMBs in the left temporo-parieto-occipital lobe relevant to language disturbance (Fig. 1b). However, there were no CMBs in the deep subcortical area and brainstem. There were no CMBs on previous GRE images obtained at a local clinic 1 month prior to this presentation as well (Supplemental Figure). While he had no symptoms at this time, he underwent brain MRI as part of a medical check-up. All laboratory tests, including coagulation profiles, were normal. He was tentatively diagnosed with (1) recurrent transient ischemic attacks and (2) mood disorder associated with medical condition. During admission, he was treated with antihypertensive agents and 100 mg of aspirin for prevention of secondary ischemic stroke. On the fourth day of admission, he suddenly developed global aphasia and right hemiparesis. Follow-up GRE images showed a large lobar hematoma with perilesional edema in the left temporo-parietal lobe where the CMBs were previously seen (Fig. 1c). Although he was referred to the Department of Neurosurgery for surgical management, he was discharged with a modified Rankin scale of 5. Our case illustrates that localized CMBs can be related to transient neurological symptoms and subsequent ICH. Although this is a single case that represents a causal relationship between CMBs and transient neurological symptoms, the association between CMBs and subsequent ICH could not be clarified, suggesting that transient Electronic supplementary material The online version of this article (doi:10.1007/s00415-012-6504-8) contains supplementary material, which is available to authorized users.