The first case is a 43-year-old woman initially noticing headache typical of her normal migraine and spelling errors on texts and Facebook posts. On exam she was found to have a left facial droop and visuospatial anomalies. Brain MRI showed multiple acute embolic infarcts in the right frontal and parietal lobes. The second case is a 66-year-old female with difficulty writing text messages and typed notes. She visited her primary care physician and was sent to an urgent care. She was found to have a left frontal subacute infarct on head CT.

Unimpaired texting requires the patient to be able to recognize and interpret previous messages, develop a response, and compose that response using intact visuospatial awareness and fine motor functions of the hand. These areas are commonly affected by stroke, but it is possible for them to be directly targeted by infarction leading to the presenting symptom of dystextia. As our two patients demonstrate, dystextia can develop after lesions of either hemisphere. The onset of dystextia can be used to determine the onset of acute stroke, which can affect time to intervention.