Unveiling aphasia: Bilateral anterior temporal lobe atrophy mimicking psychosis

Language impairment can present as a symptom of both psychiatric or a neurological condition, so making an accurate diagnosis is essential for appropriate management. While primary psychiatric disorders such as schizophrenia may include thought disorganization and speech abnormalities, true language dysfunction is typically associated with neurological pathology, such as stroke, neurodegenerative diseases, or traumatic brain injury. In cases where patients present with language impairment but lack a clear medical and psychiatric history, distinguishing between these possibilities becomes particularly challenging. A comprehensive assessment, including a neurological examination with potential imaging and a psychiatric evaluation, is crucial in these scenarios. This challenge is even more pronounced in populations such as lower-skilled migrant workers, where language barriers and a lack of collateral information further complicate the diagnostic process.

We report on a case of a patient presenting with significant language impairment who was initially misdiagnosed with a psychotic illness. The patient exhibited speech disturbances and communication difficulties that were initially interpreted as signs of disorganized thought processes, a hallmark of psychosis. However, further evaluation, including neuroimaging, revealed significant atrophy in the bilateral anterior temporal lobes, confirming a neurological basis for the symptoms. The absence of a prior medical history and limited collateral information contributed to the initial misdiagnosis.

This case highlights the critical need for a thorough psychiatric and neurological workup in patients presenting with language impairment and an unclear history. Misdiagnosis can lead to inappropriate treatment and worsen patient outcomes. A careful evaluation, including neuroimaging and linguistic assessment, is essential in distinguishing between psychiatric and neurological etiologies. Moreover, addressing barriers related to language and medical history is vital to improving diagnostic accuracy, particularly in immigrant populations.