Aphasia: A Frightening Symptom

“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.