Wernicke's aphasia after putaminal hemorrhage: Unusual clinical and SPECT findings

We present a case of a man with a putaminal hemorrhage who presented in the acute stage with a 'classic' Wernicke's aphasia. CT and MRI scans showed a large left basal ganglia hemorrhage involving the posterior putamen. A SPE CT scan performed acutely demonstrated decreased perfusion in the left temp oral cortex, frontal cortex and white matter and to the left basal ganglia from the hemorrhage itself. Within five days his language abilities improve d dramatically, with complete resolution of his aphasia over the course of six weeks. Repeat SPECT scans continued to show the structural changes to t he left putamen and left hemisphere hypoperfusion, suggesting that the reso lution of the language symptoms did not correlate with the structural and p erfusion changes. Various theories advanced in the literature regarding the pathophysiological mechanisms causing aphasia due to subcortical lesions c annot completely explain the findings of our case. These hypotheses are rev iewed and discussed.