Aphasia 101Case Study 5-3: A 46- Year- Old Woman With Predominantly
Expressive Aphasia and Telegraphic Speech as a
Complication of Heart Surgery
The restaurant is the hub of the small town and surrounding farms. It is where townspeople
discuss po liti cal issues during early morning breakfasts, lunch with each other at midday, and feast
on large T- bone and ribeye steaks in the eve ning. The bar next to the dining room is the favorite
watering hole on weekends. With her sister’s help, Charlene has run the prosperous establishment
for nearly 10 years. Twelve- hour days of planning meals and deliveries, supervising cooks and
servers, and paying bills are the norm, and Charlene never complains. At 46, she seems to have
endless energy and a commitment to the thriving business. Lately, though, she has felt more tired
than usual, and dizziness brought her to the hospital one eve ning. Over the next week, several tests
confirm a heart valve irregularity and the need for surgery.
Charlene knows that the best medical ser vices are usually found at teaching hospitals. These
hospitals usually conduct more research, have greater financial resources and better- trained
staff, and more experience with a par tic u lar medical specialty. Because of the delicate heart
surgery Charlene needs, her family wants the best. This involves traveling to the city, arranging
temporary accommodations, and closing the restaurant for nearly a month. Charlene is under-
standably ner vous, especially when she signs the paperwork acknowledging the risks involved in
the surgery, including stroke and death, and releasing the doctors and hospital from liability. At
surgery, the doctors, nurses, technicians, and anesthesiologist do a commendable job. Charlene
returns home, reopens the restaurant, and continues her life, albeit at a slower pace. It seems
that the ordeal is over.
One Sunday morning, as Charlene gets up from her lawn chair to refill her cup of coffee, her
right hand fails to grasp the cup. It crashes to the patio f loor, and she utters something unintelli-
gible to her sister. An ambulance rushes her to the nearest hospital, tests are run, and the diagnosis
is confirmed. Charlene has had a stroke.
The doctor explains to her sister that a clot has obstructed blood f low to parts of the left hemi-
sphere of Charlene’s brain. The clot prob ably originated in the heart and traveled to the brain. The
doctor believes that the heart surgery caused the clot, either directly or indirectly. He notes the
occasional premature contraction, or “f lutter,” in her heartbeat, a condition that sometimes causes
clots to form despite the medi cations used to prevent them. Charlene has Broca’s aphasia and will
need extensive rehabilitation.
Charlene’s aphasia primarily involves expressive language. At first, she did not understand
some of the words spoken by others, especially when people spoke rapidly or used complex words.
However, over a 2- week period, this prob lem subsided. Expressively, Charlene uses primarily tele-
graphic speech, in which the minimum number of function words, such as conjunctions, adjec-
tives, and articles, and many content words, such as nouns and verbs, are used to express an idea.
This condition is likely the result of her general impoverishment of words.
Charlene’s telegraphic speech is part of a larger class of language disorders called agrammatism
or syntactic aphasia, in which the patient has prob lems producing words in their correct sequence
and with proper grammar. Besides telegraphic speech, Charlene had difficulty with prepositions.
The stroke appears to have eliminated her ability to understand and use correctly words such as
over, under, above, below, and so forth. However, her telegraphic speech is the primary manifesta-
tion of the predominantly expressive aphasia.