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Neurological Rehabilitation

To Sing Opera Without Words: A case report on expressive aphasia

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Primary Author(s)

  • Gabriel Berenbeim, DO

    Resident
    Rutgers New Jersey Medical School PM&R Program
    Roseland, New Jersey

    • Co-Author(s)

  • James Guider, MD

    Resident
    Rutgers New Jersey Medical School PM&R Program
    Weehawken, New Jersey

  • KL

    Kirk Lercher, MD

    Clinical Associate Professor, Director of Outpatient TBI Services
    Rutgers New Jersey Medical School/Kessler Institute for Rehabilitation
    Woodcliff Lake, New Jersey

  • EA

    Eric Altschuler, MD, PhD

    Physiatrist
    Kessler Institute for Rehabiliation
    West Orange, New Jersey

Disclosure(s):
Gabriel Berenbeim, DO: No financial relationships to disclose
James Guider, MD: No financial relationships to disclose
Case Diagnosis: A patient with expressive aphasia after a CVA.

Case Description or Program Description: The patient is an 81 year-old male with history of hypertrophic obstructive cardiomyopathy, aortic stenosis, type two diabetes mellitus, peripheral vascular disease, obstructive sleep apnea and former tobacco use who presented to the ER with aphasia and right lower extremity weakness following a left MCA stroke for which he underwent thrombectomy with resolution of hemiparesis but continued to have aphasia and right sided neglect.

Setting: Acute inpatient rehabilitation hospital

Assessment/Results: The patient demonstrated speech deficits consistent with expressive aphasia (Wernicke's aphasia): fluent speech predominantly consisting of nonsensical words, phonemic paraphrasia and perseverant phrases or neologisms. Patient was unable to repeat simple phrases, he had difficulty repeating consonant-vowel-consonant words, showed abnormal spelling and abnormal reading comprehension. Prior to the stroke he was a wonderful amateur opera singer with a love also for jazz standards. While on the unit he would sing beautiful melodies with steady intonation and excellent pitch and tone; but the few, if any, words he sang were nonsensical. Interestingly, the patient was unbothered by his gross lexical deficits.

Discussion (relevance): A striking component of expressive aphasia is an apparent decreased insight into their language deficits. Testing if a patient has limited insight is difficult due to their limited ability to follow commands. Here is described a patient that must have decreased insight, when considering that he certainly knew the words prior to his stroke and yet is completely unfazed when less than 10% of his singing is consistent with the original lyrics.

Conclusions: Systematic studies of insight into deficits of patients with expressive aphasia are warranted. Determining how to capitalize on one's insight may enhance their recovery.