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DETROIT — Doctors in Detroit encountered the unusual case of a 40-year-old patient who had no trouble reading, writing or understanding language. His only consistent problem was that he had lost the ability to type coherent text messages on his phone.
Slurred and incoherent speech is one of the classic signs of a stroke. But new research finds that another symptom may be garbled and disjointed text messages, which could provide early clues to the onset of a stroke.
In Detroit, doctors encountered a 40-year-old patient who had no trouble reading, writing or understanding language. His only consistent problem was that he had lost the ability to type coherent text messages on his phone. An imaging scan showed that he had suffered a mild ischemic stroke, caused by a clot or blockage in his brain.
The case represents at least the second instance of what doctors are calling “dystextia.” In December, a report in The Archives of Neurology described a 25-year-old pregnant woman whose husband grew concerned after she sent him a series of incoherent text messages. Doctors found that the woman had also been experiencing weakness in her right arm and leg, and that she had earlier had difficulty filling out an intake form at her obstetrician’s office.
The case in Detroit was particularly unusual because garbled texting appeared to be the only conspicuous problem, at least initially, said Dr. Omran Kaskar, a senior neurology resident at Henry Ford Hospital who treated the patient in late 2011. “Stroke patients usually present with multiple neurologic deficits,” he said.
The findings suggest that text messaging may be a unique form of language controlled by a distinct part of the brain. And because texts are time-stamped, they may potentially be useful as a way of helping doctors determine precisely when a patient’s stroke symptoms began.
The patient was a businessman who had traveled to southeast Michigan one evening for a work trip. Shortly after midnight, the man sent text messages to his wife that were disjointed and nonsensical - and not because he was using shorthand.
One message said: “Oh baby your.” Another text, moments later, said, “I am happy.” The man later wrote that he was “out of it” and “can’t make sense.”
The next morning, he had trouble conveying his thoughts. A colleague noticed that his speech seemed slightly abnormal, and the man told him he wasn’t feeling right, Dr. Kaskar said.
At a hospital, the man was given a test that looks for impairment caused by a stroke, called the National Institutes of Health stroke scale.
A score of zero on the test indicates no stroke symptoms. Scores from 5 to 15 reflect a moderate stroke, and anything between 21 and 42 suggest a severe stroke. The man scored a 2 on the test and was given a CT scan, which showed a lesion in a part of the brain that involves language production, called Broca’s area.
The next morning, the man reported that he felt much better. Other than a slight weakness on the right side of his face, he had no visible neurological problems.
“We tested him and he had no deficits in comprehension, reading and naming objects,” said Dr. Kaskar, who is presenting his findings at an American Academy of Neurology conference this week. “He had no trouble repeating sentences that I would say, and his fluency was fine. The only abnormal finding was his texting.”
Another doctor handed the man a smartphone and asked him to type a text message with the sentence, “The doctor needs a new BlackBerry.”
“She said, ‘Type this exactly how I’m saying it, and don’t make any abbreviations or anything,’” Dr. Kaskar said.
In response, the man typed, “Tjhe Doctor nddds a new bb.”
When asked if the sentence looked correct, the man said he could not see anything wrong with it.
Because texting was his only severe problem at that time, Dr. Kaskar speculated that there might be a part of Broca’s area that handles texting as if it were a unique form of language or communication. Text messaging has emerged as an important and expressive form of language, he said, which entails “various
complexities” and abbreviations, like “btw,” “brb” and “lol.”
“It may be a new area of language that hasn’t really been explored or tested,” he said. “In humans, language evolved. Is text messaging some sort of new specific language that the brain is developing?”
Whether that turns out to be true or not, the case, like the one described in December, suggests that doctors may at times be able to use time-stamped text messages to pinpoint when stroke symptoms began. Figuring out the time of onset can help doctors determine the course of treatment and whether or not to use acute interventions.
“In other words, time is brain,” Dr. Kaskar said. “The sooner a stroke is detected and treated, the better the outcome.”
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