J Korean Neurol Assoc.  2000 May;18(3):333-336.

A Case of Aphasic Status with Brain 99m-Tc Ethyl Cysteinate Diethylester Single Photon Emission Computed Tomography Demonstrating Focal Hyperperfusion

• Kim HY
• Shon YM
• Seo DW
• Na DL

Abstract

We present a 79-year-old male with aphasic status that was confirmed by a 99m-Tc ethyl cysteinate diethylester (ECD) single photon emission computed tomography (SPECT). He was admitted to our hospital due to a sudden onset of aphasia. In a Korean-version Western Aphasia Battery (K-WAB) test, the patient was diagnosed with Wernicke's aphasia (aphasia quotient (AQ)=54.50). In a brain magnetic resonance image (MRI) revealed the lesion of an old intracranial hemorrhage in the left posterior temporal area. An electroencephalography (EEG) showed continuous slowing in the left temporal area. SPECT demonstrated focal hyperperfusion in the left temporal cortex anterior to the lesion. After the administration of phenytoin, the aphasia was much improved (follow-up K-WAB : AQ=70.00). In follow-up studies two months later, EEG showed no interval changes and SPECT revealed no focal hyperperfusion in the left temporal area. Simple partial seizure is not easy to diagnose especially when manifesting with nonmotor symptoms such as aphasia. In this case, Wernicke's apha-sia was the only manifestation of epileptic seizure, the EEG did not show any definite epileptiform discharges. SPECT showed focal hyperperfusion in the left temporal area which was supposed to be a seizure focus. We conclude that SPECT might be useful in diagnosing a simple partial seizure manifesting as aphasia without EEG change.

Keyword

Aphasic seizure; Intracranial hemorrhage; Brain SPECT; K-WAB

MeSH Terms

Aged
Aphasia
Brain*
Electroencephalography
Epilepsy
Follow-Up Studies
Humans
Intracranial Hemorrhages
Male
Phenytoin
Seizures
Tomography, Emission-Computed, Single-Photon*
Phenytoin