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Crossed aphasia in early childhood
1Medical Center Rehabilitation Hospital, Department of Pediatrics, University of North Dakota.
Insights
A child
Area of Science:
- Neurology
- Pediatrics
- Speech-Language Pathology
Background:
- Pediatric stroke involving the middle cerebral artery is rare.
- Early childhood stroke can lead to significant neurological deficits.
Observation:
- A four-year-old experienced a right middle cerebral artery infarct, presenting with left hemiplegia and aphasia.
- Post-stroke, the child developed hemiparesis, word-finding difficulties, and enuresis.
- Long-term sequelae included elective mutism, attention and memory deficits, and persistent enuresis.
Findings:
- The case highlights a potential association between right-hemispheric lesions and withdrawn behavior, challenging typical left-hemispheric lesion-depression correlations.
- Elective mutism emerged as a significant, though often temporary, symptom in this pediatric stroke case.
- Persistent deficits in attention and academic skills were observed despite speech recovery.
Implications:
- Elective mutism should be considered a diagnostic criterion in pediatric crossed aphasia evaluations.
- Comprehensive neurorehabilitation addressing cognitive and academic impairments is crucial for children post-stroke.
- This case underscores the complex and varied long-term outcomes of pediatric arterial ischemic stroke.
Abstract:
A four-year-old child was admitted to hospital with an infarct of the right middle cerebral artery involving the frontoparietal area. His symptoms included left hemiplegia and aphasia. After two weeks, he had hemiparesis, word-finding and naming problems and enuresis. A year later he demonstrated elective mutism at school, had attention and short-term memory impairments, occasional enuresis and an average IQ. He was shy and withdrawn; this is interesting, since depression is usually associated with left-hemispheric lesions. It is suggested that an early period of mutism should be included among the criteria for the study of crossed aphasia in children, as this is a common occurrence in such cases. Even after recovery of speech, impairments in attention and academic skills may persist.