Bilingual aphasia due to spontaneous acute subdural haematoma from a ruptured intracranial infectious aneurysm

Vajramani, Girish V., Akrawi, Hawar, McCarthy, Rosaleen A. and Gray, William P. (2008) Bilingual aphasia due to spontaneous acute subdural haematoma from a ruptured intracranial infectious aneurysm. Clinical Neurology and Neurosurgery, 110, (8), 823-827. (doi:10.1016/j.clineuro.2008.05.008).


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We report a case of spontaneous subdural haematoma due to ruptured intracranial infectious aneurysm, presenting with bilingual aphasia and illustrating differential language recovery. A 62-year-old right-handed bilingual gentleman, with a diagnosis of infective endocarditis, developed headache and became expressively aphasic in the English language. Three days later he was receptively and expressively aphasic in both English and Arabic. Cranial MRI scans showed a left-sided acute subdural haematoma with mass effect and midline shift. Contrast CT brain scans showed an enhancing speck adjacent to the clot and cerebral angiogram confirmed a distal middle cerebral artery aneurysm. He underwent image-guided craniotomy, evacuation of the subdural haematoma and excision of the aneurysm. Histopathological examination was consistent with an infectious intracranial aneurysm. Postoperatively his aphasia did not improve immediately. He had widened pulse pressure due to severe aortic regurgitation, confirmed on echocardiography. He underwent aortic valve replacement and mitral valve repair, following which his aphasia recovered gradually. Initially the recovery of his language was limited to Arabic. About a week later he recovered his English language as well. At 3-year follow-up he is doing well and has no neurological deficits. His aphasia has recovered completely. The present case is unique because of (a) presence of pure subdural haematoma, and (b) the differential susceptibility and recovery of native (L1) and acquired language (L2) in presence of a common pathology. The neurology of language in a bilingual is analysed and possible mechanisms discussed.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1016/j.clineuro.2008.05.008
ISSNs: 0303-8467 (print)
Related URLs:
Keywords: bilingual aphasia, infectious intracranial aneurysm, mycotic aneurysm, subdural haematoma
Subjects: R Medicine > RD Surgery
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
B Philosophy. Psychology. Religion > BF Psychology
Divisions : University Structure - Pre August 2011 > School of Medicine
University Structure - Pre August 2011 > School of Psychology > Division of Clinical Neuroscience
ePrint ID: 70253
Accepted Date and Publication Date:
September 2008Published
Date Deposited: 27 Jan 2010
Last Modified: 31 Mar 2016 12:59

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