Case Report: Epilepsy-related pure word deafness in the elderly: an underreported presentation?

We describe a rare case of epilepsy-related PWD in the elderly. A 61-year-old right-handed man presented with status epilepticus. Although electroencephalogram revealed no epileptiform discharges, brain magnetic resonance imaging (MRI) showed hyperintensity in the left temporoparietal lobe and thalamic pulvinar on diffusion-weighted imaging (DWI). Cerebrospinal fluid revealed no pleocytosis and negative PCR results for herpes simplex virus and varicella-zoster virus. Following the recovery of consciousness, he exhibited a profound dissociation between auditory and speech/language modalities: he was unable to comprehend or repeat spoken language but could follow complex written instructions and fluently produce grammatically correct speech. He had largely preserved perception of non-verbal sounds. Despite minor accompanying oral reading deficits interpreted as concomitant symptoms of an extensive lesion, he was diagnosed with epilepsy-related PWD. Following the administration of levetiracetam, the patient's language function recovered significantly within 20 days. This case suggests that PWD represents an overlooked, transient manifestation of dementia-like symptoms in late-onset epilepsy. Due to its rapid reversibility, such cases are likely underrecognized and underreported; further documentation is warranted.