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 SPECT scan performed acutely demonstrated decreased perfusion in the left temporal cortex, frontal cortex and white matter and to the left basal ganglia from the hemorrhage itself. Within live days his language abilities improved dramatically, with complete resolution of his aphasia over the course of six weeks. Repeat SPECT scans continued to show the structural changes to the left putamen and left hemisphere hypoperfusion, suggesting that the resolution of the language symptoms did not correlate with the structural and perfusion changes. Various theories advanced in the Literature regarding the pathophysiological mechanisms causing aphasia due to subcortical lesions cannot completely explain the findings of our case. These hypotheses are reviewed and discussed.