Global Aphasia Following Right Hemispheric Ischemic Stroke: A Rare Case Report

Introduction: Global aphasia is a severe language disorder involving both perceptive and expressive abilities, commonly caused by a left hemispheric stroke due to its typical language lateralization. Rarely, it is associated with right hemispheric lesions, which can be explained by atypical language lateralization. Case presentation: We report a rare case of a 53-year-old left-handed male presenting with global aphasia following an ischemic stroke in the right hemisphere. The patient experienced sudden left-sided hemiparesis and progressive speech impairment after an episode of chest pain. Neurological examination revealed left supranuclear facial nerve paresis, positive babinski reflex on the left side, and severe language deficits, including inability to speak, comprehend, repeat, read, or write. Due to imaging limitations, thrombolysis was not performed. The patient was treated with oxygen, antiplatelet therapy, lipid-lowering medication, neuroprotective agent, and glucose control. Imaging at the referral hospital confirmed ischemia in the right frontotemporoparietal region, homologous to the left hemisphere’s language-processing areas. Discussion: This case illustrates that global aphasia can result from right hemispheric strokes due to atypical language lateralization. Factors contributing to this atypical lateralization include left-handedness, genetic predisposition, anatomical variations, and neuroplasticity. Management focused on addressing the ischemic stroke, treating comorbid conditions, and planning for speech therapy as a critical component of rehabilitation. Conclusion: Recognizing atypical language lateralization is crucial for accurate diagnosis and effective management of global aphasia following right hemispheric strokes, especially in left-handed individuals. Increased clinical awareness can lead to timely interventions and improved patient outcomes. Keywords: global aphasia, right hemisphere, ischemic stroke, atypical language lateralization