Correspondence Address:
Hulya Ozkan
Department of Neurology, Faculty of Medicine, Trakya University, Edirne
Turkey

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Dear Editor,

Dysphasia is usually an acute stroke finding, but an epileptic cause must be considered if it occurs episodically, it shows fluctuations, or the underlying lesion cannot be shown in the imaging of the brain. Epileptic seizures originating from the frontal or temporal lobes of both hemispheres can cause aphasia. A long-lasting, fluctuating Wernicke dysphasia may be the finding of a nonconvulsive status epilepticus (NCSE) even if the patient may not have a prior epilepsy history.[1],[2] Here, we report a patient with NCSE presented with Wernicke dysphasia.

A 68-year-old right-handed male patient was brought to the emergency department due to lack of understanding. Neurological examination revealed that the patient had a fluent speech, impaired comprehension, naming, and repetition. The patient had no prior history of epilepsy. Magnetic resonance imaging revealed an old bleeding site in the left parietooccipital area, whereas the electroencephalography (EEG) showed lateralized periodic discharges (LPDs) with a frequency of 1.5 Hz in the left hemisphere. LPD was partially reduced after diazepam infusion (10 mg intravenous), but no significant change was observed in the clinical condition due to sedation-induced sleepiness. The patient was started on levetiracetam 1500 mg/day on suspicion of NCSE. The following day, the speech, comprehension and naming completely recovered, and the EEG of the patient became normal [Figure 1].{Figure 1}

NCSE presented with Wernicke dysphasia is rarely encountered and is difficult to diagnose. It may be confused with other causes of aphasia and conversion disorders, especially if the patient has no prior history of epilepsy. In previous reports, the most common clue for NCSE has been the fluctuation in dysphasia, and definitive diagnosis could be made with EEG.[1],[2] Diagnosis of NCSE was delayed from 1 day to 21 days. As in our patient, EEG was normal and clinical the findings of the cases completely recovered in 1–3 days after the initiation of an antiepileptic medication.

In cases with unexplained altered mental status, NCSE should be considered and EEG should be taken for diagnosis. In 37% of patients who have unexplained altered consciousness, EEG and clinical findings have been found compatible with NCSE.[3]

Miyaji et al.[4] reported that 29% of the 127 patients with late epileptic seizures after cerebrovascular event suffered from nonconvulsive seizures and 9% had NCSE. Marcuse et al.[5] reported that NCSE was observed in 24 (2%) of 1101 patients with brain tumors, of which four had the only clinical manifestations of speech disorder.

We emphasize that NCSE should be considered in the differential diagnosis of acute, long-lasting fluctuating isolated aphasia. In case of clinical suspicion from NCSE, EEG should be performed as soon as possible and antiepileptic treatment should be started.

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