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Brain, Vol. 111, No. 3, 631-641, 1988
© 1988 Guarantors of Brain

research-article

ACUTE TRANSCORTICAL MIXED APHASIA

A CAROTID OCCLUSION SYNDROME WITH PIAL AND WATERSHED INFARCTS

JULIEN BOGOUSSLAVSKY1,, FRANCO REGLI1 and GIL ASSAL2

1From the Department of Neurology, Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland 2Division of Neuropsychology, Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland

Correspondence to: Correspondence to: Dr J. Bogousslavsky, Department of Neurology, CHUV. 1011 Lausanne, Switzerland.

Four of 1 200 consecutive patients with their first stroke showed acute transcortical mixed aphasia (TMA) characterized by nonfiuent speech with impaired naming, semantic paraphasias, echolalia, impaired comprehension, good repetition, reading, and writing on dictation. All 4 had left internal carotid artery (ICA) occlusion with ipsilateral anterior pial territory infarction (precentral-central sulcus artery territory) and watershed infarction between the middle and posterior cerebral artery territories, which spared and ‘isolated’ the perisylvian speech areas. Although rare, acute TMA is highly suggestive of infarction due to ICA occlusion, in that it is probably related to simultaneous embolism (anterior pial infarction) and haemodynamic insufficiency (posterior watershed infarction).

Received April 7, 1987. Revised September 22, 1987. Accepted October 7, 1987.


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