A 69-year-old African-American woman with a history of arterial hypertension and diabetes was evaluated because of sudden onset of speech difficulties.

Our patient had sudden onset of language difficulties. The video shown was obtained within 24 hours of symptom onset. On initial evaluation, her spontaneous speech was markedly reduced but not to a state of mutism. She was able to utter only a few words (e.g., well, yes, and OK). Naming, repetition, and comprehension of spoken language were compromised. Reading and writing (not shown) were also affected. She had a minimal right central facial paresis, a right-hand pronator drift, and a right Babinski sign.

Despite minimal associated neurologic deficits, her acute aphasia fits best with a nonfluent, nonrepetitive aphasia with impaired comprehension, thus resembling a global aphasia. Further investigations showed an acute left frontal infarction and an occluded cervical left internal carotid artery at its origin.

We suspected intracranial embolism to be the most likely mechanism of her frontal infarction. She was treated with aspirin and received speech therapy. Her aphasia subsequently evolved into a Broca aphasia.