title: Crossed Wernicke's aphasia after aneurysmal subarachnoid hemorrhage: a case report.
abstract: Crossed aphasia (CA) refers to aphasia occurring after right brain damage in right handers. In the literature, numerous CA cases following cerebral ischemia have been reported, but few met the criteria for a prompt diagnosis. The authors present the case of a 52-year-old woman with SAH caused by a right middle cerebral artery (MCA) saccular aneurysm who developed non-fluent aphasia characterized by reduced verbal output, word-finding disturbances and phonemic paraphasias in both oral and written language. 99mTc-HMPAO SPECT was also consistent with right parieto-temporal and frontoparietal ischemia with crossed cerebellar diaschisis on the right cerebellum. A diagnosis of CA was made. One year follow-up showed improvement in communication skills but persistent right fronto-temporo-parietal ischemia. Cerebral vasospasm after aneurysmal SAH symptomatology may vary from motor and sensory disturbances to cognitive disabilities. Aphasia developing after cerebral ischemia of the right hemisphere in a right-hand dominant patient following vasospasm may be a misleading symptom for the localization of the insult. Keeping a high index of suspicion may help in making the correct diagnosis. The changes in the perfusion patterns of cerebellum as assessed by SPECT study during the acute and recovery phases suggests the involvement of cerebellum in language functions.
authors.affiliation: Dişkapi Yildirim Beyazit Eğitim ve Araştirma Hastanesi, 2. Beyin Cerrahisi Kliniği, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Seçkin
authors.forename: Kazim
authors.initials: K
authors.lastname: Yiğitkanli
authors.forename: Ozlem
authors.initials: O
authors.lastname: Kapucu
authors.forename: Murad
authors.initials: M
authors.lastname: Bavbek
mesh_terms: D001041:Aphasia, Wernicke / Q000000981:diagnostic imaging / Q000209:etiology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D002531:Cerebellum / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology*