Images in Neurology |

Dystextia:  Acute Stroke in the Modern Age

Arvind Ravi, PhD; Vikram R. Rao, MD, PhD; Joshua P. Klein, MD, PhD
JAMA Neurol. 2013;70(3):404. doi:10.1001/jamaneurol.2013.604.
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A healthy 25-year-old right-handed pregnant woman, gravida 1, para 0 at 11 weeks' gestational age, was brought to the emergency department after sending her husband a series of confusing text messages regarding their baby's due date (Figure, A). At the time, she had just concluded a routine visit to her obstetrician's office, where she was retrospectively noted to have difficulty accurately completing her intake form. She additionally recalled an episode of acute weakness of her right arm and leg earlier in the morning that had lasted for a few minutes before resolving and for which she did not seek medical attention.

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Figure. Reproduced transcript and neuroimaging correlates of texting dysphasia. A, Transcript of text message conversation between the patient (P) and her husband (H). Patient's replies are notable for use of high-frequency words, social phrases, and neologisms. Spelling autocorrection function had been previously disabled on her mobile device. B, Axial diffusion-weighted magnetic resonance imaging shows reduced diffusivity in the left insula. Apparent diffusion coefficient maps (not shown) revealed corresponding hypointensity, confirming acute ischemic infarction. C, Maximal-intensity projection 3-dimensional time-of-flight magnetic resonance angiography shows a filling defect in the inferior division of the left middle cerebral artery (arrow). A relative paucity of vascular markings are noted throughout the distal left middle cerebral artery territory.




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