A 46-year-old female presented with complaints of dyspnea and chest pain. Patient was found to have STEMI followed by ventricular tachycardia cardiac arrest. Patient had successful resuscitation after 8 minutes followed by intubation and successful right coronary artery stent placement. The following day, patient was extubated and found to have complete aphasia, right facial droop, and right-hand weakness. Subsequent imaging with CT angiogram with perfusion studies were unremarkable. Further workup with MR brain imaging showed a moderate sized left MCA territory involving the basal ganglia, frontal operculum, and lateral precentral gyrus. Physical exam over the next few days demonstrated loss of fluency, intact comprehension, and writing. Patient could vocalize sounds but was unable to articulate syllables or form complete words. Both language and speech were affected. Writing was intact but she misspelled common words including her name.  Due to her speech deficit, she was not able to verbally repeat words spoken to her. Motor exam of cranial nerves 2-12 was intact.

This is a rare case of acute stroke causing a speech deficit severely out of proportion to the deficit in writing. Patient displayed difficulty with articulation but had largely preserved language comprehension. Patient displayed signs of atypical Broca’s aphasia which is suggestive of aphemia.