Dados do Trabalho

Título

“ATRIAL MYXOMA'S EMBOLIZATION AND STROKE CAUSING APHASIA IN A BILINGUAL (PERSIAN AND PORTUGUESE) IRANIAN GIRL: A CASE REPORT”

Apresentação do caso

A 12 years old iranian girl, who lived in Brazil for 5 years previously to the stroke, and was bilingual (persian and portuguese). On october 2016 the girl suddenly presented seizures, hemiparesis and aphasia. Tests for immunological, infectious and coagulation diseases were normal; echocardiogram showed a 39 x 17 mm tumor in the left atrial cavity, that was surgically excised 20 days after. The patient came to our Rehabilitation Hospital only 6 months later. Her first language was persian, and she started learning portuguese when she was 5 years old. Prior to the stroke, she was fluent for both languages, either for speaking, reading and writing. After, she developed aphasia for both languages, facing more problems with her first language. In portuguese, she presented expression aphasia, with anomias, semantical, phonemic and morphemic paraphasias, besides paralexias and paragraphias.
Magnetic resonance (08/08/2017) showed ancient isquemic vascular accident at left medial cerebral artery, justifying patient´s aphasia.
Sequential brain images, including a tractography study prior and 9 months after the rehabilitation program, initially showed important reduction at the number of the left arcuatus fasciculus, which affects connections at the primary language areas at the left cerebral hemisphere, that were damaged by the stroke.
Tractography at 01/11/2018 showed a small increase at the number of the right arcuatus fasciculus, that represents neuroplasticity with increase at the number of connections at areas on the right cerebral hemisphere.

Discussão

Although aphasia is one of the most common sequelae after a stroke episode, it is a rare condition in children, specially when it is related to primary cardiac tumors, like the myxomas.
Tractography findings showed that even 9 months after the stroke, at the primary area of language, at the dominant hemisphere, still there was anatomic changes, after the intervention.
The most expressive increase at the right arcuatus fasciculus may suggest that the right hemisphere might be compensating the language deficits secondary to damage at primary language areas at the dominant hemisphere.

Comentários finais

It´s very important to consider rare conditions as a cause for a stroke in children and teenagers.
The existence of independent linguistic subsystems to process different languages at the bilingual person might be the reason why both languages were damaged at different degrees.

Referências (se houver)

Xing S, Lacey EH, Skipper-Kallal LM, Jiang X, Harris-Love ML., Zeng J., Turkeltaub PE. Rigth hemisphere grey matter structure and language outcomes in chronic
left hemisphere stroke. Brain, Volume 139, Issue 1, 1 January 2016, Pages 227–241, https://doi.org/10.1093/brain/awv323
Zipse L, Norton A, Marchina S, Schaug G. When right is all that is left: plasticity of right-hemisphere tracts in a Young aphasic patient. Ann N Y Acad. Sci. 2012
Apr;1252:237-45. doi: 10.1111/j.1749-6632.2012.06454.x.
Scherer LC. Investigating bilingual afasia: a focus on discourse production. Estudos Linguístios, São Paulo, 40 (2): p. 944-954, mai-ago 2011
Gómez-Ruiz MI. Bilingualism and the Brain: Myth and Reality. Neurologia. 2010;25 (7):443-452
Garcia AM, Egido JA, Barguero MS. Mother tongue lost while second language intact: insights into afasia. BMJ Case Rep. 2010; 2010. doi: 10.1136/bcr.07.2009.2062
Ihsen Z, Hela M, Khadija M, Zouhayer J. Cerebral embolism complicating left atrial myxoma: a case report. Pan African Medical Journal. 2016; 24:140 doi:10.11604/
pamj.2016.24.140.9778
design: salvefabio@gmail.com
BRAZIL Domanski O, Dubois R, Jegou B. Ischemic Stroke due to a Cardiac Myxoma. Pediatric Neurology. 2016 (65): 94-95

Fonte de Fomento (se houver)

Declaração de conflito de interesses de TODOS os autores

Não temos conflito de interesses.

Área

Doenças cerebrovasculares e terapia intensiva em neurologia infantil