(Kiosk 3) A Rare Case of True Right Brain Dominance, Broca’s Aphasia After Right Middle Cerebral Artery (MCA) Stroke: A Case Report

Case Diagnosis: 82-year-old left-handed female presented with Broca's Aphasia after right Middle Cerebral Artery (MCA) stroke

Case Description or Program Description: The patient initially presented with non-fluent language impairments. Stroke workup with Computed Tomography (CT) Angiogram identified an area of ischemia in the lateral right frontoparietal region and moderate to severe stenosis of a small distal right M3 MCA branch in the region of the right postcentral gyrus. Subsequent Magnetic Resonance Imaging (MRI)revealed moderate right MCA territory acute infarct in the region of right MCA M3 branch stenosis. She was not a candidate for thrombolysis or thrombectomy. On initial evaluation by the inpatient rehabilitation speech language pathologist, she was noted to have effortful non-fluent verbal output with marked word-finding difficulty and anomia, as well as comprehension deficits. She was also noted to have findings consistent with both oral apraxia and dysarthria which further impacted her communication. With written language support she was oriented to person, place, and time, and was able to follow simple one-step commands.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: The patient demonstrated a moderately severe undifferentiated non-fluent aphasia, most consistent with Broca's aphasia, with verbal expression further impacted by apraxia of speech and dysarthria.

Discussion (relevance): Although historical discussions have postulated that left-handed patients have right brain dominant language centers, Broca’s aphasia associated with Right hemispheric strokes are rare. Language impairments in most patients with right hemispheric dysfunction include apraxia rather than a Broca’s aphasia, regardless of handedness.

Conclusions: Language assessments in right hemispheric dysfunction in left-handed individuals should include assessment for Broca’s aphasia in addition to apraxia of speech, thus informing use of appropriate communication strategies for the patient’s rehabilitation course.