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Aphasia: A Frightening Symptom

19 Feb

“I knew something wasn’t right as soon as I opened my mouth.”

I am sure many of you, whether you saw it live or later on a news broadcast, looked on in shock as Emmy Award-winning CBS reporter Serene Branson broadcast live from the recent Grammy Awards in Los Angeles. Myself, and likely every other physician watching, knew exactly what this was.

Aphasia.

That was the symptom anyway. The cause was not so apparent. Her garbled speech probably made many of you first think that she had had a stroke or perhaps drugs must be involved. A stroke was definitely a possibility, and in fact that or a Transient Ischemic Attack (TIA) were very likely, but drugs not so much. She wasn’t intoxicated or disoriented or slurring her words as would be the case with drugs.

She was scared. Rightly so.

I thought she handled the entire episode exceptionally well under the circumstances. Imagine yourself live on national TV and the words that form in your head leave your mouth as nonsense gibberish? But she didn’t panic though the fear she felt was written on her face. She threw things back to the studio and waited for them to pick up the ball. Watch the video and you will witness a classic example of acute expressive aphasia. Seen it too many times to count. You will also witness a very brave and professional woman exhibit poise–grace under pressure.

Even though her aphasia was apparent, the exact cause of it wasn’t. Not on that brief clip. That would come later after she underwent an evaluation and fortunately for her the news on that front turned out to be good.

So, what is aphasia?

 

 

Aphasia is a fascinating and very complex neurologic disorder that can be divided into two basic types: Receptive and Expressive. Receptive aphasia is an inability to comprehend visual or auditory information while expressive aphasia is an ability to communicate words or thoughts. Each can occur separately or in combination and each comes in many varieties.

In a receptive aphasia, the person might not be able to comprehend spoken words, written words, pictures, or objects. For example, if someone wrote down the word watch, the victim might not be able to say the word yet could point to a watch or a picture of a watch. Or the victim might be shown a watch and be unable to say the word, yet be able to write it down. Or vice versa–he might be able to write it down but not say it. Or someone might say the word watch and the victim might be able to write the word on a piece of paper but be unable to identify a watch laying on a table before him. And again, vice versa. He might be able to identify it but not write it. Victims of receptive aphasia have difficulty perceiving what they see and hear and their symptoms come in many flavors.

An expressive aphasia is the inability to say what the person wants to say. He might know the words in his head, know what he wants to say, yet be unable to speak them.

Some individuals have a combination of an expressive and a receptive aphasia. In its severest form this is called global aphasia. People with this type of disorder have, as you would imagine, a great deal of trouble communicating.

What causes this odd problem? Things like strokes, tumors, trauma, infections, psychiatric disorders such as schizophrenia, certain drugs, and migraines. Yes, migraines.

Migraine headaches are not simply very painful headaches. They are complex neurological events and can even occur with no headache. They are in the broader family of vascular headaches, as are Cluster Headaches, since they seem to arise from alterations of blood flow to the brain due constriction (narrowing) and dilation (opening) of the arteries that supply blood to the brain. This results in auras and migraine associated symptoms and signs such as nausea, dizziness, photophobia (light sensitivity), phonophobia (sound sensitivity), visual light flashes and scotomas, partial blindness including tunnel vision and hemianopsias, numbness, paralysis, confusion, disorientation, auditory and visual hallucinations, and the list goes on to include aphasia.

It seems that Serene Branson had a combination of expressive and receptive aphasias. The video clearly shows an expressive component but in interviews I’ve read she said that before she went on the air she felt odd and when she looked at her notes the words made no sense. That’s a receptive problem.

Regardless, from the reports I’ve read it appears that a migraine syndrome is what caused Ms. Branson’s aphasia and that’s much better than a stroke or a tumor. With proper treatment she should do fine and be back at work very soon. I know we all wish her the best.

 
17 Comments

Posted by on February 19, 2011 in Medical Issues

 

17 responses to “Aphasia: A Frightening Symptom

  1. Joanie Scott

    February 19, 2011 at 4:39 pm

    Good article, but the word ‘victim’ makes me wince a little. My 18 year old daughter suffered a stroke in 2009 when she was 18 and has aphasia.

    It’s good that this news story has brought the word aphasia to people’s attention as it affects a million people in the US – although of course we feel sympathy for Serene Branson and are glad it was nothing more serious.

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    • D.P. Lyle, MD

      February 19, 2011 at 4:43 pm

      Yes, getting the word out is important and hopefully this will help if even a little bit. Thanks for your input on this. I hope your daughter does well.

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  2. Lee Lofland

    February 19, 2011 at 4:49 pm

    As always, good article, Doug.

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  3. Laura K Curtis

    February 19, 2011 at 5:47 pm

    I’ve had episodes of aphasia associated with my epilepsy over the years. It is a horrible, horrible feeling. I’ve been analyzed by neuropsychologists, who are the doctors you tend to start with if you complain of memory problems, etc, that no one can see. My aphasia manifests as the inability to come up with certain words. For example, I may mean to say “home,” but I can’t think of it. I have to say “the house where I live.” The neuropsych I went to said the problem for me is that–as a writer and an academic–my tolerance for memory loss and aphasia is much lower than most people’s. I notice when I can’t get the exact word, whereas other people wouldn’t be bothered.

    I can’t imagine how Serene Branson felt. She makes her living with words, and she’s used to being in total control. Thank goodness it seems as if it wasn’t anything permanent.

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  4. Joanna Aislinn

    February 20, 2011 at 7:41 am

    As an occupational therapist by day, I’ve dealt with patients with both types of aphasias. As a writer, too, I have a good sense how frustrating not being able to communicate can be. I also got to live through my dad’s episode during TIA’s he had two nights in a row. (I was at work during his first bout and the slurring had stopped by the time I’d gotten home. I do remember how scared he was.)

    Thanks for this article. Haven’t worked with adults in quite a while, but if I remember correctly the aphasia could extend itself to the written word. Had a lady who was able to write checks once I made a ‘cheat sheet’ of the number words she’d need to string together on the appropriate line. (FYI: this technique is still in use by my mom, who came from Italy sixty years ago. She speaks plenty of English but sometimes needs help with spelling words. English doesn’t necessarily follow any real ‘spelling rules’ lol.)

    Joanna Aislinn
    Dream. Believe. Strive. Achieve!
    NO MATTER WHY
    The Wild Rose Press
    http://www.joannaaislinn.com
    http://www.joannaaislinn.wordpress.com

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  5. Shirlsmor

    February 20, 2011 at 10:46 am

    I’m afraid your classification system is in error. Aphasiologists no longer dichotomize aphasia into expressive and receptive varieties, since all people with aphasia demonstrate some difficulties in both understanding/reception of language and speaking/writing of language. Global aphasia is not a combination of expressive and receptive aphasia, but simply refers to someone whose language functions are severely impaired across all of these modalities, and is usually the result of a large lesion in the distribution of the middle cerebral artery. Current classification relies upon site of lesion and falls generally within two categories: the fluent, and the non-fluent aphasias. The neurological classification system is much more helpful in defining areas of difficulty and in treatment. While getting the word out about aphasia is a good idea, it is important to keep the information within the current culture of aphasia.

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    • D.P. Lyle, MD

      February 20, 2011 at 11:08 am

      Thanks for your input. Fascinating stuff. It points out how medicine and nomenclature evolve and change. Having been in the business for forty years I’ve seen virtually everything change, mostly due to this or that committee coming up with a knew way of saying things. I’m sure this “new” classification is one of those and someday it too will fall by the wayside and be replaced by another “new” naming structure. Such is medicine. For example, what they called the various types of lymphoma when I was in school and what they call them now are totally different, a result of them having gone through several nomenclature changes–yet they are still the same disease. Often these changes arise from a better understanding of the disease anatomy or physiology or its genetic make up or its response to various treatment modalities and other factors. Most neurologists I deal with out here in the trenches still use the “old” classification of expressive and receptive and mixed and I think it still has validity. Yes, the various types of aphasia mix and mingle and on a case by case basis are difficult if not impossible to pigeon hole. Isn’t that true of everything in medical science? I’ve seen many, many patients with aphasia and no two have been alike. Again, thanks for your input.

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  6. Teresa

    February 20, 2011 at 1:13 pm

    Dr. Lyle:
    I always enjoy your blog.
    I have visual migraines which causes zigzag lights to flash through my vision, then blacks out parts of my vision, makes one side of my face numb. One arm and hand partially disfunctional and my tongue numbs so I can’t speak clearly.
    I’ve had them since I was pregnant with my second child. And Yes, I thought I’d had a stroke the first time it happened. Scared me silly. They are also accompanied by a smell just before they hit. I once asked a neurologist if epilepsy and migraines were connected and if some of the same medications they prescribe for epilepsy could be used for migraines.
    He was fascinated that as a lay person I would put the two together and said yes it had been tried.

    I’m so glad Ms. Branson is making a full recovery. It’s terrifying to feel so helpless.

    Write on,
    Teresa Reasor

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  7. Brenda

    February 20, 2011 at 5:46 pm

    Thanks for the interesting article.

    I became aware of what aphasia was when my dad developed Creutzfeldt-Jakob Disease. So very sad. He already could not talk much from it and I was with him when he found he could not read at all and could no longer stand to be in the bookstore we were visiting. It is an awful disease for anyone and everyone, but even worse for those who love reading and thinking and realize what is happening.

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  8. Tony Trapp

    August 14, 2015 at 8:51 pm

    Thank you D.P. Lyle, MD for this I have a aphasia I had a stroke 1.5 years ago, sometimes its very frustrating to me, I feel depressed as well, I just want to be normal again, my typing is ok, before the stroke I was a web developer so I need my brain to function right, I can still code just fine, but sometimes I can’t speak, thank you Dr from the bottom of my heart.

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    • D.P. Lyle, MD

      August 15, 2015 at 7:30 am

      Tony—thank you for your note. I know aphasia in all its forms can be very frustrating. Take care of yourself—and laugh a lot—it’s good medicine.

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  9. Amanda Lauren

    October 17, 2015 at 8:07 am

    I get migraine attacks with aphasia. It is possibly the scariest thing to experience and makes you feel as thought you will next find words again. It only last about an hour so I cannot imagine how people feel who have to deal with it all the time. I feel like the migraines are triggered by stress and then cant be controlled and they just come on and take over. Does anyone have any recommendations on how to control them or make them go away faster? I have noticed sleeping and drinking cocacola helps but if anyone has recommendations that would be nice.

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  10. joan

    January 30, 2016 at 3:28 pm

    I am breathing a very large sigh of relief. Yesterday, I had an ocular migraine – flashing zig-zag lights in one eye, resolving in about 25 minutes. I’ve had these episodes for about 30 years and they have always quickly resolved. But yesterday, I had a strange experience post-aura. I had an appointment at the hairdresser and on arrival, another client struck up a conversation with me and I was unable to form a coherent sentence. It was frightening and when my appointment was over, I went immediately home and to bed. I came here hoping to find an explanation and I have! Thank you.
    In retrospect, I can recall a time about five years ago when prepping for a colonoscopy and I became nauseated, disoriented, and aphasic. Cancelled the procedure and my doctor had me go at once for an MRI/MRA. Results negative. Now I’m thinking it was the same experience I had yesterday and I’m no longer terrified. I will of course let my doctor know on Monday but I’m relatively sure it isn’t emergent. Thanks for being here.

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    • D.P. Lyle, MD

      January 31, 2016 at 10:00 am

      Yes see you doctor. Though these symptoms can definitely be part of a migraine syndrome the can also mean something else. Get it checked out soon.

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  11. Lana Csbanas

    November 16, 2016 at 4:39 pm

    So what can you do about the aphasia?

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    • D.P. Lyle, MD

      November 17, 2016 at 7:46 am

      Very little. It will either resolve on its own or not–though Speech and Occupational therapy does help it’s really up to the healing process as to how much ability returns.

      Like

       

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