Stroke Victim Saying the Same Thing Over and Over Again
Bewilder Neurocogn Disord. 2019 Mar; eighteen(1): xxx–32.
Improvement of Post Stroke Echolalia later Using Selective Serotonin Reuptake Inhibitors
Heewon Bae
Department of Neurology, Veterans Health Service Medical Center, Seoul, Korea.
JaeYoung Park
Section of Neurology, Veterans Health Service Medical Center, Seoul, Korea.
YoungSoon Yang
Department of Neurology, Veterans Health Service Medical Center, Seoul, Korea.
Received 2019 Feb 24; Revised 2019 Feb 25; Accepted 2019 Apr nine.
Echolalia is a linguistic communication disorder of repeating the same words and coping what others speak. Information technology can announced as a linguistic communication damage afterwards cerebral infarction and at that place are few other treatments besides language rehabilitation.1 Mail service stroke emotional incontinence (PSEI), which shows emotional changes of pathologic laughing or crying is effective to serotonin reuptake inhibitor (SSRI).2 Although PSEI does not include language disorder, they have a common characteristic in that they both occur later cerebral infarction and have a serotonin related machinery. This written report reports a case of symptomatic comeback using SSRI in echolalia after cerebral infarction.
An 85-year-old man was unable to speak suddenly, iii days after undergoing radiofrequency catheterization with atrial fibrillation. The patient was trying to speak but could non make a sound. According to neurological examination, the patient had a trend of being drowsy and responded to the stimulation. There was slight motor weakness on the right side with no pathological reflex. At outset it was thought to be Broca's aphasia.
Encephalon improvidence-weighted epitome showed multifocal ischemic lesion in the left frontal lobe, parietal lobe and cerebellum. Brain MR angiography showed focal stenosis in M1 segment of right middle cerebral artery and proximal internal carotid avenue (Fig. 1A and B). The patient was taking rivaroxaban only switched taking to dabigatran. Three days later the handling, the patient began to speak simple words intermittently. In the language test, the patient had no spontaneous voice communication; however, he tended to echo the words that he could hear. He could sympathize simple sentences, and it was therefore thought to be a transcortical motor aphasia. The patient's verbal symptoms improved during the treatment, but he began to feel depressed. A week after treatment, serotonin administration was initiated, because the patient's condition, and taking into account both depressive mood caused by language disorder and PSEI. 10 days afterwards admission, the Korean version of the Western aphasia test was conducted to accurately evaluate linguistic communication disorders. The patient was cooperative in the test merely his ability to pay attention was poor. He could answer merely one out of the half dozen questions asked. Fluency decreased and there were just automatic spoken expressions in repetition. The recognition of auditory sentences was somewhat possible but he repeated the last 4 words of the sentences of the question. Based on the results, the aphasia of the patient was classified every bit transcortical motor aphasia co-ordinate to the Kertesz classification table. However, the echolalia was prominent. Thus, FDG-PET was conducted and it showed hypo-metabolism in left frontal, parietal and temporal lobe (Fig. 1C and D). A month afterwards serotonin therapy, his depressive mood and echolalia symptom improved.
Initial lengthened weighted prototype showed ischemic lesion in left cognitive hemisphere (A, B). FDG-PET image of the patient showed hypo-metabolism in Left frontotemporal lobe on axial (C), coronal (D) planes.
Echolalia is a disorder of repeating other's words. It happens in autism spectrum disorder, merely tin also appear in neurodegenerative dementia and mail service stroke aphasia.three Echolalia subsequently stroke is mainly accompanied by transcortical motor aphasia and represents well-nigh 4%–xx% cases of aphasia.iv
Although the exact mechanism of the disease has not been identified, it can be seen in medial frontal, inductive cingulate cortex and subcortical lesions. As in above case, it resulted in the dysfunction in ability to acquire, recall and control linguistic communication of left frontal lobe lesion.5
There is also a hypothesis from a neurochemical aspect, that information technology could exist caused past immunoexcitotoxicity in the encephalon damage because of serotonin concentration modify, resulting in dysregulation of language or memory.vi In this case, the patient was diagnosed with cerebral infarction in the left hemisphere, and at showtime, he was marked by echolalia. In the case of echolalia continuum, the patient had poor communication and showed automatic echolalia, which is moderate.3 Later on, he was scheduled to accept language rehabilitation, merely was given SSRI considering his depressive mood due to the possibility of PSEI. Although follow up FDG-PET showed aggravation of frontotemporal lobe uptake, linguistic communication symptoms were recovered later about a month of SSRI assistants. PSEI appeared in both pathologic laughing and crying, in the grade of emotional symptoms that occurred after cerebral infarction.2
Recently, there have been reports of various emotional incontinence related to serotonin, it tin therefore be idea to be related to the machinery of echolalia mentioned above.ii In fact, echolalia is not within the PSEI category. However, there are reports of echolalia later cerebral infarction, and symptoms of linguistic communication tin can also be induced PSEI or related to similar mechanisms. Therefore, through the improvement of echolalia, which is effective by the use of SSRI, it can exist concluded that echolalia is associated with PSEI and it can be consider as a language incontinence. Also, serotonin-related effects can be expected on other language disorder such equally paralalia and perseveration, subsequently cognitive infarction.
Footnotes
Disharmonize of Interest: The authors have no fiscal conflicts of interest.
Contributed by
Author Contributions:
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Data curation: Park JY.
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Supervision: Yang YS.
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Writing - original draft: Bae HW.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494782/
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