America witnessed a dramatic example of expressive aphasia, or speech arrest, when Serene Branson began speaking incoherently while reporting on-air about the Grammys. According to news reports, her symptoms resolved within a few minutes at the most, and she refused further medical assistance after the paramedics found her vital signs to be stable. Many people are wondering what could have caused such a dramatic and sudden, but thankfully brief, loss of speech.
There are numerous possible causes of sudden aphasia that fully resolves after a short time period. These include seizures, brain hemorrhages, low blood pressure, low blood sugar, multiple sclerosis and inflammatory conditions of the brain and blood vessels, however, what comes to mind first is a transient ischemic attack (TIA), a “warning stroke” or “mini-stroke” that produces stroke-like symptoms but no lasting damage.
TIAs are highly significant because they are often precursors of major strokes, leading to permanent neurologic dysfunction. Therefore, it is important to diagnose the cause of a TIA and treat it appropriately and rapidly.
A TIA occurs when there is a brief reduction of blood flow to a portion of the brain, but with resumption of adequate blood flow before damage to that area occurs. The reduction in blood flow can be due to a piece of “debris” breaking off a plaque in a narrowed, diseased artery in the neck. It can also be caused by a high degree of narrowing of an artery in the neck or brain so that the blood flow through that artery is profoundly reduced for a brief period of time. These events usually occur in individuals over the age of sixty.
Another cause of TIA can be due to an abnormality in the heart, such as an infection or abnormal heart rhythm. In these instances a small piece of “debris” can be released from the heart into the blood stream and then into the brain. A TIA can also be caused by birth control pills, blood disorders and drugs such as cocaine. Inflammation of arteries, referred to as arteritis, is another cause of TIAs.
In addition, a focal seizure (a seizure in a small part of the brain) can manifest as a brief loss of neurologic function, including a brief episode of aphasia like the type Serene Branson experienced. Again, there are numerous possible causes for the new onset of a seizure. A brain tumor, drug reaction, brain hemorrhage or low blood sugar are all possible causes of a focal seizure.
Even when someone recovers fully and feels well after a brief episode of aphasia, as apparently was the case with Serene Branson, the individual needs a full and careful medical evaluation. Not only do they need an MRI of the brain, which may in fact be normal, but the arteries in the neck and the heart also need to be fully evaluated. Additionally, blood tests need to be performed. Without appropriate diagnosis and treatment, a permanent stroke could ensue or a minor hemorrhage in the brain could lead to a major hemorrhage. If a seizure has occurred, a subsequent seizure might be more profound. The early stage of an infection, such as encephalitis, could become a life-threatening infection of the brain.
Certainly Ms. Branson will have a thorough medical evaluation and, hopefully, the cause of her episode of aphasia will be found to be readily treatable and she will not suffer future neurologic dysfunction.