warfarin and Aphasia

Topics: Adult; Aphasia; Cerebral Infarction; Early Diagnosis; Echocardiography; Follow-Up Studies; Headache; Humans; Hypereosinophilic Syndrome; Imatinib Mesylate; Magnetic Resonance Imaging; Male; Risk Assessment; Secondary Prevention; Treatment Outcome; Warfarin

"Dystypia", characterized by an impairment of typing on a keyboard, is a unique neurobehavioral syndrome. A 77-year-old right-handed woman developed a relatively selective impairment of typing after ischemic stroke. The MRI documented new scattered ischemic lesions in the middle cerebral artery territory of the left hemisphere and an old infarct lesion in the frontal area of the right hemisphere. The standard neuropsychological tests showed no aphasia, normal praxis, intact visuospatial ability, and a mild visual memory disturbance. The detailed analysis documented severe impairment of writing and reading abilities for Romaji (Romanized Japanese), spelled by alphabet letters and the most common way to input Japanese into computers. The writing and reading abilities for other Japanese linguistic modalities such as kanji (morphogram: Chinese character), kana (syllabogram: Japanese proper character), and alphabet letters, were not or minimally impaired. A disturbance of linguistic processing for Romaji may be the main underlying neural mechanism for dystypia in this patient.

Topics: Aged; Agraphia; Anticoagulants; Antipyrine; Aphasia; Diffusion Magnetic Resonance Imaging; Drug Therapy, Combination; Edaravone; Female; Free Radical Scavengers; Heparin; Humans; Japan; Language; Stroke; Stroke Rehabilitation; Warfarin; Word Processing

A 69-year-old man who had essential thrombocythemia, for which he was taking no medications, suddenly developed aphasia and right hemiplegia and was admitted to the hospital. He was thought to have had an embolic stroke and was initially treated with warfarin. Although the international normalized ratio was in the therapeutic range, he had 3 additional ischemic stroke episodes with the same symptoms after the index stroke. Magnetic resonance angiographic examinations revealed serial changes in middle cerebral artery stenosis. After administration of an antiplatelet agent and hydroxyurea, he had no additional strokes.

Topics: Aged; Anticoagulants; Aphasia; Brain Ischemia; Cerebral Angiography; Cilostazol; Diffusion Magnetic Resonance Imaging; Hemiplegia; Humans; Hydroxyurea; Infarction, Middle Cerebral Artery; International Normalized Ratio; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Perceptual Disorders; Platelet Aggregation Inhibitors; Stroke; Tetrazoles; Thrombocythemia, Essential; Warfarin

Topics: Adult; Angiography, Digital Subtraction; Anticoagulants; Aphasia; Carotid Artery Thrombosis; Coronary Angiography; Humans; International Normalized Ratio; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Paresis; Patient Care Planning; Recovery of Function; Stroke; Tomography, X-Ray Computed; Warfarin