A 66 year-old right-handed male patient with a history of hypertension was brought to emergency room because of sudden onset speaking problem.
His speech was fluent, but he was not aware of, and did not correct, his errors in speaking. The frequent paraphasias and neologisms, combined with agrammatism, along with the high word output, lead to completely incomprehensible gibberish, termed jargon aphasia, or word salad. Since the patient lacked awareness of the deficit, he actually appeared euphoric.
Physical examination showed no weakness. Sensation and acuity field were difficult to evaluate.
The most likely clinical localization is in the left posterior superior temporal and left inferior parietal region. This region is supplied by the left MCA inferior division.
The most likely diagnosis, especially given the patient’s age, history of hypertension, and acute onset, is an infarct in this territory. Hemorrhage in this location is also possible. Ischemic stroke was then confirmed by head CT-scan.
It is worth noting that the most common mechanism of this territory infarction is embolism. So patient should be carefully evaluated to exclude all possible causes of the emboli.
- Campbell, W. W., & DeJong, R. N. (2005). DeJong’s the neurologic examination (No. 2005). Lippincott Williams & Wilkins.
- Caplan, L. R. (Ed.). (2016). Caplan’s stroke. Cambridge University Press.