1406 - Crossed Aphasia Following Right Internal Carotid Artery Dissection Secondary to Fibromuscular Dysplasia in a Right-Handed Patient.

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CH

Caleb Hoover, DO

Preliminary medicine resident
Internal Medicine - University of Alabama at Birmingham - Montgomery
Montgomery, Alabama, United States

Submitter(s)

CH

Caleb Hoover, DO

Internal Medicine - University of Alabama at Birmingham - Montgomery
Montgomery, Alabama, United States

Case Diagnosis: Crossed aphasia resulting from a right internal carotid artery dissection secondary to fibromuscular dysplasia.

Case Description: A 51-year-old right-handed female with hypertension and Horner syndrome presented to the emergency department with left-sided weakness and dysarthric speech. Neuroimaging revealed a right internal carotid artery dissection with a distal M1 occlusion, attributed to fibromuscular dysplasia (FMD). She was initially treated with heparin, transitioned to apixaban, and admitted to inpatient rehabilitation. On admission, strength was 4/5 in the left upper and lower extremities. A Western Aphasia Battery-Bedside (WAB-B) evaluation confirmed Broca's aphasia with severely impaired fluency, speech content, and writing, though comprehension was preserved.

Discussions: Crossed aphasia, a language impairment following a right hemispheric lesion in right-handed individuals, accounts for less than 1% of aphasia cases. This patient’s case is unique in that crossed aphasia developed secondary to a right ICA dissection linked to FMD, an etiology not previously associated with this syndrome. For clinicians, and particularly physiatrists in the rehabilitation setting, early and precise diagnosis of aphasia subtypes using tools such as the WAB-B is critical for guiding interdisciplinary rehabilitation, particularly in tailoring speech-language therapy and supporting functional recovery. Although neurovascular imaging is essential in stroke workup, structured language assessments are equally critical to characterize deficits and guide long-term rehabilitation.

Conclusions: This case highlights a rare presentation of crossed aphasia in a right-handed individual following stroke due to FMD-related vascular pathology. Recognition of this unusual syndrome is essential for accurate lesion localization, targeted aphasia rehabilitation, and secondary stroke prevention. Additionally, awareness of atypical stroke mechanisms broadens the scope of differential diagnosis and long-term management.