A 56 yo patient with a left parietal ICH has aphasia – no surprise there. One residents comes out of her room and notes that she has severe difficulty formulating sentences yet her understanding is quite okay. 10 minutes later the SLT pathologists reports severe restriction in understanding: she can follow commands only when underscored by gestures and mimic. The two professionals discuss these findings and call the attending to obtain a final verdict. All three enter the room and find a severely aphasic patient, barely able to form single words and no understanding at all. 5 minutes in the exam, a first complete sentence is formed and she seems to understand everything, talking about her job and family when questioned.
There are at least 3 good explanations for these short-lived neurological changes in stroke, SAH, tumour and ICH patients:
- hemodynamic instability
- spreading depression (CSD)
- Dreier. The role of spreading depression, spreading depolarization and spreading ischemia in neurological disease. Nat Med 2011
- Lauritzen. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab 2011
- Oliveira-Ferreira. Spreading depolarization. Future Neurology 2011