The study was conducted according to the principles of the Declaration of Helsinki. The patient gave his informed consent to participate. LA was a 53-year-old, right-handed male, with 8 years of education. On April 6, 2020, after 2 weeks of fever, the patient was admitted to an emergency room with signs of aphasia and behavioural agitation. A chest X-ray scan revealed the presence of mild interstitial pulmonary signs. Serological tests (IcG Ab) confirmed the presence of antibodies for SARS-CoV-2. FLAIR-MRI imaging revealed the presence of hyperintense signal in the temporo-parieto-insular regions of the left hemisphere extending subcortically to the homolateral semioval centres (Fig. 1). This signal was compatible with an ischemic stroke of the middle cerebral artery probably because of thrombophilic processes, probably elicited by SARS-CoV-2. The signal, indeed, appeared discontinuous, and it was characterized by thromboembolic elements distributed in different divisions of the middle cerebral artery (M3, M4). Finally, the midline brain structures were normally aligned and there was no evidence of hemorrhagic conversion.
LA was admitted to our neurorehabilitation unit to receive comprehensive neuropsychological assessment concerning his left-hemisphere syndrome. His previous medical history was unremarkable, except for a visual deficit in the left eye. Neurological examination did not reveal sensory or motor deficits, but LA had a fluctuating sense of temperature in his right hemisoma. LA was alert, collaborative, and aware of his linguistic difficulties. The patient was fully oriented to time, space, and person. Furthermore, he did not show signs of mnestic or executive dysfunction in everyday life.
A comprehensive neuropsychological assessment was then performed (see Tables 1 and 2). LA’s praxis was normal: the patient did not show any signs of ideomotor or constructional apraxia. His oral production was fluent, both with reference to spontaneous tasks (i.e. conversation) and to elicited tasks (i.e. picture description; semantic and phonemic verbal fluency, except for phoneme A). Articulatory and prosodic deficits were absent. The syntactic structure of LA’s utterances was intact, suggesting the absence of agrammatism. His oral and written comprehension was intact, both for single words and for sentences (see also Token test, Table 2). Number processing and calculation were also intact. Oral and written naming of pictures representing nouns, verbs, and colours was largely spared. Nevertheless, LA produced some phonological paraphasias and he made attempts to self-correction (conduit d’approach).
In contrast, LA showed some signs of conduction aphasia. Although oral repetition of spoken single words and non-words was intact, the patient was severely impaired in orally repeating spoken sentences. Reading aloud words, non-words, and sentences was intact. On the contrary, writing was severely impaired. More precisely, on writing to dictation, the patient produced many paragraphias, which were mainly characterized by the omission or substitution of graphemes. Paragraphias were present for single words, non-words, and sentences.