Non-Organic Language Disorders after Awake Brain Surgery

Awake surgery with Direct Electrical Stimulation (DES) is the ‘gold standard’ to resect brain tumours in the language dominant hemisphere (1). Milian et al. (2) stated that most patients tolerate the awake procedure well and would undergo awake surgery again if necessary. Intraoperative pain is reported in 30%, strong anxiety in 10-14% of the patients. Post-traumatic stress disorders were not found in the early postoperative phase (3) nor during longitudinal follow-up (4). However, postoperative psychological symptoms such as recurring distressing dreams related to the awake surgery and persistent avoidance of stimuli associated with the awake procedure were recorded (4,5). To the best of our knowledge, psychogenic language problems after awake brain surgery have never been described. In general, non-organic language disorders (language symptoms that cannot be explained by any underlying organic disorder, or that are not proportional to the extent of the underlying pathology) have been rarely reported in the literature (6). We report a patient with a tumour in the left anterior temporal lobe resected under local anaesthesia. The postoperative (atypical) linguistic symptoms were incompatible with the lesion location, suggesting a psychogenic origin. The language and behavioural characteristics of this patient are described and compared with the findings of De Letter et al. (6). Additionally, the etiology of the psychogenic language disorders is discussed.