Echolalia Following Acute Ischemic Stroke

Abstract

A 66-year-old man, known to have hypertension and type II diabetes, presented to the Emergency Department with sudden onset right-sided weakness and speech disturbance. He was conscious, alert but not attentive. His initial National Institutes of Health Stroke Scale (NIHSS) was 17. The patient was noted to have severe aphasia, with poor comprehension and a tendency to echo the examiners' speech sounds and words (videos 1). He also showed impairment in naming, reading, and writing. An upper motor neuron pattern right facial weakness was noted. His brain CT showed no hemorrhage or large vessel occlusion (LVO). He was treated with intravenous tissue plasminogen activator (tPA). MRI revealed acute infarction, predominantly involving the left parieto-occipital lobes (Figure 1). He improved dramatically within 8 days of rehabilitation and speech therapy (video 2).