Kraepelin's schizophasia: Chaotic speech with preservation of comprehension and activities of daily living

BACKGROUND

In his classic account of dementia praecox Kraepelin reserved a few pages for a small number of psychotic patients with disorganized speech but who retained the ability to cope with their daily lives.

CASE REPORT

A 49-year-old homemaker has been suffering from a continuous hallucinatory-delusional state since she was 24 years old. Her verbal and written language was chaotic and full of neologisms, but fluent and grammatically correct. Speech disorganization was roughly proportional to the need to express ideas and thoughts through creative speech. She followed verbal, written, and visuo-gestural commands and flawlessly repeated words and sentences of variable length. She read aloud and discussed the news properly. She ran the house, cooked for her relatives, and went to the supermarket and the bank alone. She knew the prices of common goods and handled money with ease. The unique coexistence of (i) chaotic speech, (ii) preservation of aural, written, and gestural comprehension, and (iii) organized non-verbal behavior, in patients (iv) in a chronic delusional-hallucinatory state is the hallmark of the syndrome of "schizophasia" originally described by Kraepelin. The main features of Kraepelin's schizophasia are vividly illustrated by videos and photos of the patient during her daily life.

DISCUSSION

The differential diagnosis of schizophasia is reviewed, especially with the sensory aphasias (Wernicke's and transcortical), from which the confusional speech of our patient was differentiated by her preserved ability to repeat and understand spoken and written language. Because her primary language abilities were spared, the cardinal deficit seems to lie at the interface where thoughts and ideas are encoded into expressive language.

CONCLUSION

The expression "Kraepelin's schizophasia" should be restricted to the speech-behavioral dissociation first observed by Kraepelin in chronic psychotic patients. The term "schizophasia", in turn, should be kept as a generic designation for any language alteration in schizophrenia.

Transcortical sensory aphasia heralding SARS-Cov-2-induced autoimmune encephalitis with gyral restricted diffusion hyperintensities: a novel case report

Background

Coronavirus disease 2019 (CoVID-19), primarily thought of as a respiratory system disease is actually a multi-system disease with immunological implications. CNS involvement in COVID has been explained in recent literature mainly for stroke, encephalopathy, encephalitis, acute disseminated encephalomyelitis and myelopathy. There are few studies characterizing clinical spectrum of COVID autoimmune encephalitis. We present a unique case of post-COVID autoimmune encephalitis in a diabetic male presenting with language dysfunction and novel radiologic findings.

Case presentation

Patient admitted to inpatient department of a tertiary care hospital of India was evaluated by bedside clinical examination, routine blood tests, CSF study with intrathecal SARS-Cov-2 antibody detection, commercially available tests for autoimmune encephalitis, neuroviral panel with HSV PCR, EEG, 3-Tesla MRI and PET scan. Patient was found to have personality change and transcortical sensory aphasia in the outset of COVID encephalitis. MRI findings like temporal involvement and insular ribboning are also being reported. The patient was treated with IV immunoglobulin and is on an improving course.

Conclusions

This case reports dysphasia due to COVID-mediated injury to the language networks, with novel radiologic findings. Role of parainfectious versus immune etiology is also discussed. Further studies are needed to elucidate the mechanism and clinical spectrum of post-COVID autoimmune encephalitis.

Completion phenomenon in transcortical sensory aphasia

We investigated completion phenomenon for proverbs in cases demonstrating transcortical sensory aphasia due to a variety of diseases. Lack of this completion was exclusively observed in patients with focal atrophy. These patients showed a selective and consistent impairment in word comprehension without phonemic cue effects in naming. The completion phenomenon was present in patients demonstrating transcortical sensory aphasia due to other cerebral diseases. In these patients, comprehension deficits were not selective for words, or words not comprehended were inconsistent and some phonemic cue effects were observed. In a previous study, we reported that completion phenomena for multiplication tables, serial numbers and names of days were frequently noted in patients with focal atrophy. Together with the present findings, these results suggest that lack of proverb completion may be attributed to a selective, systematic and complete loss of the meaning representations for language units such as words and proverbs. In addition, pathological processes of focal atrophy with temporal predominance might selectively affect the semantic memory for language as a unit.