Acute mixed transcortical aphasia with bihemispheric neurological deficits following diffuse cerebral dysfunction

A 78 year old man presented with acute mixed transcortical aphasia with intact naming and bilateral involvement of the motor systems following a left internal carotid artery stenosis. The CT scan showed hypodense areas in the border zones of the left hemisphere together with diffuse areas of ischaemia. Intact repetition the hallmark of transcortical aphasias and the exceptional preserved naming in this patient support the earlier findings that the contralateral hemisphere could mediate some aspects of language function. The patient also had bilateral motor abnormalities which could be explained on the occipito-parietal lesion. It is suggested that widespread hypofunction of the left hemisphere following cerebral ischaemia could give rise to bihemispheric neurological deficits which could be short lived and could possibly be attributed to bilateral cerebral blood flow changes that may occur with the hemispheric lesion.