Another cause of isolated aphasia – Illicit drug abuse

Abstract It is because of the distribution of the MCA that isolated aphasia is uncommon. This case reminds us of the risk of stroke in illicit drug use while highlighting another cause of stroke with isolated aphasia. We present a 50 year old male with no prior medical history, who presented because his wife noted he was unable to speak. When seen, his physical examination revealed expressive aphasia and agraphia without any other focal neurological deficits. A brain CT showed a large area of loss of gray-white differentiation to the left frontal lobe including the insular cortex with associated sulcal effacement. An MRA confirmed subacute ischemic injury involving the left MCA distribution with focal narrowing of an M2 branch within the sylvian fissure. Carotid artery doppler, echocardiogram, lipid profile, and thrombophilia workup were negative. His cause of stroke was therefore assumed to be secondary to illicit drug abuse. Isolated aphasia is usually secondary an embolic event. As illicit drug related vasculopathy is an accepted proposed mechanism for ischemia, it should be highlighted that illicit drugs can also be a cause of this uncommon presentation of stroke.