Episodic Aphasia Associated With Cortical Spreading Depression After Subdural Hemorrhage Evacuation

Abstract

Cortical spreading depression (CSD) has been associated with many pathological entities including migraine, trauma, hemorrhage, and mitochondrial disease. The clinical diagnosis remains challenging without the other concomitant features such as headache because CSD can mimic seizure or acute stroke. Wereport of a 77 year-old right handed man with a left subdural hematoma evacuation that subsequently developed episodic aphasia, slurred speech, right nasolabial fold flattening, and right pronator drift. In this case report, we discuss our multimodal diagnostic approach and treatment in a patient with episodic aphasia and neurological deficits in order to propose the diagnosis of cortical spreading depression. CSD should be considered when focal deficits in brief episodes occur after stroke and seizures have been ruled out. Treatment choices as illustrated by this case report can have an impact on outcome and resolution of episodes.

Acephalgic Intracranial Hypotension: Subdural Haematoma Resolution After Blood Patch

“…7 Interestingly, our patient's response to topiramate, as opposed to levetiracetam, supports the increasingly recognised efficacy of this agent on cortical spreading depression, which is the presumed pathophysiological mechanism of paroxysmal neurological events in patients with SDHs. 8 It is also worth noting that topiramate's ability to decrease CSF production, through the inhibition of carbonate anhydrase, did not in our case interfere with the positive outcome.…”

The Role of Astrocytes in Migraine with Cortical Spreading Depression: Protagonists or Bystanders? A Narrative Review

“…Cortical spreading depression (CSD) is associated with many diseases, including migraine, trauma, cerebrovascular disease, and mitochondrial disease [ 1 ]. The relationship between migraines and CSD has been extensively studied.…”