Garbled Speech Reporter's Aphasia Video With Physician Analysis.

While at my  physical therapy appointment today getting my shoulder worked on my therapist alerted me to a viral video of Los Angeles reporter Serene Branson appearing  to be have a stroke during a live television broadcast of The Grammy Awards Show of 2011. In this ABC YouTube video below she is displaying what I believe to be a classic case of expressive aphasia.  Aphasia is a medical term that means speechless.  There are two main types of aphasia us medical types are taught during medical school.  Both are frequently signs of stroke or transient ischemic attack (TIA) or complex migraine syndromes.  They are receptive aphasia and expressive aphasia and both signs suggest malfunction of the the language centers of our brain.

What is receptive aphasia?  In simple terms, a patient with receptive aphasia (Wernicke's aphasia affecting Brodmann area 22)  can speak relatively  normal sentence structures, but their language does not make sense in the context of their conversation  Their brain is unable to process what they hear others saying.  What is expressive aphasia?  In simple terms, a patient with expressive aphasia (Broca's aphasia affecting Brodmann area 44) is unable to formulate appropriate words and sentences. 


In an undrugged, healthy atraumatic young female who presents with expressive aphasia, I would consider her to have a stroke until proven otherwise, because a stroke can have long term devastating effects.   At the very least, that looked like a TIA to me. In the absence of drugs, intoxication, migraine or trauma or even intentional misrepresentation of the truth to make a boring report go viral on the internet,  I can't think of anything other than a stroke or TIA or migraine that would cause her to speak as she did. She very clearly had a break down of her brain's language center.  Why would a young female present with such a dramatic stroke like finding?  My differential diagnosis of the causes of stroke in this patient might include (in no specific order)
  • Use of birth control pills
  • Illicit drug use and smoking
  • Genetic predisposition to clot, specifically the presense of an antiphospholipid antibody (APL)
  • Atrial fibrillation, although exceedingly rare in young healthy women
  • Patent foramen ovale
  • Vasculitis or other autoimmune disorder
  • Genetic extreme cholesterol levels
  • Cancer related thrombophilia
  • Hematological malignancy with exceedingly high Hgb, WBC or platelet count
  • No medical explanation
What kind of work up will this Grammy Awards reporter with garbled speech likely get?   Labs will likely include:
  • CBC
  • CMP
  • ESR
  • ANA
  • TSH
  • APl Ab, Factor 5 Leiden, Prothrombin G20210 mutation, homocysteine, Protein C and S, PT/PTT, 
  • Fasting lipid panel,
  • UA with micro
Radiology and other cardiovascular evaluations will likely include:
  • Noncontrast screening head CT without contrast.  
  • MRI with and without contrast
  • CTA of the head and neck or MRA (CTA will give you better images)
  •  Transesophageal cardiac echo
  • Carotid dopplers
  • Telemetry
  • Chest X-ray
  • EEG
What happens next for Serene Branson?   I suspect if everything comes out intact, she will be told to stop her birth control pills if she's on them and she'll be told to take a baby aspirin once a day. If this was a TIA, she will be at an exceedingly high risk for transforming to full blown stroke in the first thirty days after her sentinel event. For a young otherwise healthy patient with no adjustable risk factors for stroke, this is the kind of life changing event that will certainly make  one ask themselves, "why me?"

UPDATE February 18th, 2011:  Find out what  Serene Branson's diagnosis was determined to be. 

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