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26.12.12

Dystextia

There's a fascinating, very short report out in JAMA marking the first case where text messaging abnormalities were the first signs of a neurological abnormality.

The paper, "Dystextia - Acute Stroke in the Modern Age", documents the case of a pregnant woman who suffered a small "acute ischemic infarction" (stroke) in her left insula (below). As per medical radiological tradition, the right side of the brain image represents the left side of the patient's brain, because they flip them (supposedly because that's how they see the patients when they're facing them?)




She was brought into the emergency room after the following text message conversation with her husband about their baby's due date (P - patient; H - husband):

H: So what’s the deal?
P: every where thinging days nighing
P: Some is where!
H: What the hell does that mean?
H: You’re not making any sense.
H: July 24, right?
P: J30
H: July 30?
P: Yes
H: Oh ok. I’m worried about your confusing answers
P: Butithink
H: Think what?
P: What i think with be fine

What's interesting about this is that the patient had been hypophonic (soft speech) due to a recent upper respiratory illness, which the authors conclude may have masked her strange speech patterns:
"As the accessibility of electronic communication continues to advance, the growing digital record will likely become an increasingly important means of identifying neurologic disease, particularly in patient populations that rely more heavily on written rather than spoken communication."
While this is a cool presentation of modern technologies encroaching upon the medical world, what's fascinating to me, from a neuroscientific perspective, is the location of her stroke and its effects. In 1996 Nina Dronkers scanned the brains of 25 patients with apraxia, or the inability to coordinate speech movements, and found that 100% of the patients had lesions in only one spot: the left insula (which was also found to be lesioned when she performed MRIs of Broca's original patients).


This is an old argument, but provides strong evidence that the insula is an important player in coordinating speech movements.

Even if that "speech" is actually just texting on your iPhone.


ResearchBlogging.org
Ravi, A., Rao, V.R., & Klein, J.P. (2012). Dystextia: Acute Stroke in the Modern AgeDystextia Archives of Neurology DOI: 10.1001/jamaneurol.2013.604
Dronkers, N. (1996). A new brain region for coordinating speech articulation Nature, 384 (6605), 159-161 DOI: 10.1038/384159a0
Dronkers NF, Plaisant O, Iba-Zizen MT, & Cabanis EA (2007). Paul Broca's historic cases: high resolution MR imaging of the brains of Leborgne and Lelong. Brain : a journal of neurology, 130 (Pt 5), 1432-41 PMID: 17405763