Ictal aphasia: an unusual presentation of temporal lobe seizures

Language disturbances during epileptic seizures are not uncommon, but isolated speech impairment is rare. We report a 67-year-old male with sudden onset of aphasia initially thought to be the result of an infarction of left middle cerebral artery territory. He had recurrent episodes of non-fluent, severely aphasic speech with intact comprehension as the primary manifestation, without other clinical seizure activity. After the administration of antiepileptic medication, his language returned to the baseline level. This case suggests that paroxysmal non-fluent aphasia can result from a seizure focus in the dominant temporal lobe. This is an important differential to be considered in patients with aphasia, which will assist in early diagnosis and treatment.