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Stroke lesion size and location are understood to be more accurate predictors of recovery from aphasia than demographic variables such as age, education, or socioeconomic status. We hypothesise that markedly high premorbid language function can influence functional recovery from aphasia. This case study reports the recovery of a 64-year-old right-handed male, with large left posterior cerebral artery territory infarct involving the thalamus, occipital lobe and posteromedial temporal lobe. The report is informed by retrospective review of clinical notes, language assessment, and interviews with the participant and his family. Premorbidly, he had acquired fluency in five additional languages in early adulthood, followed by a career in senior roles within corporate communications. Following severe expressive aphasia in the acute period, the subacute and chronic phases were characterised by residual mild anomia and cognitive communication difficulties apparent on formal assessment, yet masked in functional contexts through compensatory strategies and preservation of an authoritative premorbid communication style. The current report provides single-case evidence that individuals with markedly high premorbid metalinguistic skills may, in functional contexts, be able to compensate for expressive aphasic deficits and preserve their communicative competence. The discrepancy between the participant’s performance on formal versus informal language assessment underscores the necessity for both perspectives for accurate diagnosis of aphasia. Consideration of premorbid language function can usefully guide clinical decision-making about intervention for individuals with aphasia.

Premorbid language function: a prognostic factor for functional outcome in aphasia?