LETTER TO THE EDITORWernicke’s aphasia and attempted suicideAntonio Carota 1,2 • Francesca Rimoldi 2 • Pasquale Calabrese 2Received: 26 December 2015/Accepted: 9 February 2016/Published online: 4 March 2016? Belgian Neurological Society 2016Poststroke depression (PSD) is the most frequent mooddisorder in early and late phases after stroke onset. Recentstudies indicate that 30–40 % of stroke patients suffer fromthis disorder [1] and prevalence is supposed to be evenhigher in patients with aphasia [2]. Suicidal ideation mightoccur in 15 % of stroke patients, doubling the prevalence inthe normal population [3]. PSD is one of the most impor-tant risk factors for suicide in stroke patients [4]. Thus,early diagnosis and treatment are crucial. However, theassessment of PSD and suicide ideation in patients withsevere aphasia poses serious challenges.We report the case of a 66-year-old right-handed manwith persisting Wernicke’s aphasia (WA), 16 years after aleft perisylvian stroke due to atrial f i brillation. The patientwas not known for prestroke mood disorders.Residual def i cits were severe WA, right homonymoushemianopia, right faciobrachial paresis and hypoesthesia.Spontaneous language was f l uent, but uncommunicativedue to continuous phonological and verbal paraphasias(jargonophasia). Comprehension of auditory, written andvisually presented material, naming, repetition, reading andwriting were severely reduced. Finally, the patient wasunable to process any kind of communication, even bygesticulation or pantomime.In spite of aphasia, the patient’s autonomy was pre-served for daily living activities. He was able to walk witha cane and to participate together with his wife in fewscheduled activities and social events. Aphasia therapy waswithdrawn several years before because of the recurrenceof irritability and anger in coping with linguistic tasks.Few days before Christmas, 16 years after stroke, thepatient shot himself in the head with a pellet gun, which hehad moved secretly from the storage basement into hisbureau. Brain CT-scan showed the lead bullets, whichpierced the temples throughout the orbits, sectioning theoptic nerves outside the cranial cavity (Fig. 1). The patientbecame blind, but the brain remained grossly uninjured. Nosurgery was performed. Citalopram was introduced and thedose increased progressively to 60 mg/day. The patientspent 2 months in a psychiatric hospital, 1 month in arehabilitation hospital and 2 months in a nursing homebefore being discharged home.After the suicidal attempt, there were no possibilities ofassessing mood with standardized questionnaires or scales.To our knowledge, this is the f i rst report of a premedi-tated suicide attempt of a patient with WA. The peculiarclinical feature of this case is that the attempted suicideoccurred 16 years after the stroke without warnings.Aphasia is a frequent consequence of stroke (about30 % of patients in the acute phase) [5]. Althoughimprovement of linguistic faculties generally occurs withvariable degree over the f i rst year, about 50 % of patientsare left with long-term residual def i cits [5]. Stroke patientsexperience high frustration when verbal communication isimpaired.& Antonio Carotaacarota@genolier.net; a.carota@bluewin.chFrancesca RimoldiFrancesca.Rimoldi@unibas.chPasquale CalabresePasquale.Calabrese@unibas.ch1GSMN Neurocenter, Genolier Clinic, Genolier SwissMedical Network, Route du Muids 3, CP 100, 1272 Genolier,Switzerland2Division of Molecular and Cognitive Neuroscience,Neuropsychology and Behavioral Neurology Unit, Faculty ofPsychology and Interdisciplinary Platform Psychiatry andPsychology, University of Basel, 4055 Basel, Switzerland123Acta Neurol Belg (2016) 116:659–661DOI 10.1007/s13760-016-0618-1
