In February, 2013, a 39-year-old bilingual medical practitioner attended our hospital after she developed difficulty expressing herself in English. She was a native Welsh speaker and had been fluent and literate in both English and Welsh from childhood. Suddenly, she had become unable to initiate or complete sentences spontaneously in English, while remaining fluent in Welsh. Her medical history was unremarkable. She did not smoke and had no history of hypertension or diabetes. 6 months earlier she had given birth to a healthy infant after an uneventful pregnancy and 3 months afterwards had developed lethargy, which she attributed to the aftermath of pregnancy. She had no fever or headaches, and specific symptoms of hypo-thyroidism such as cold intolerance or constipation were absent. On arrival to hospital she was alert and oriented and had normal blood pressure and ECG. She had no goitre and her reflexes were intact. Motor system and cranial nerve examinations were normal. A detailed language assessment by a bilingual physician elicited an expressive dysphasia that was present in English but not in Welsh.
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