DOI: https://doi.org/10.36347/sjmcr.2026.v14i08.015

Pages: 1832-1834

Background: Transient focal neurological symptoms frequently resolve before medical evaluation, creating a diagnostic challenge in primary care. While transient ischemic attack (TIA) is an important consideration, determining the underlying cause in younger adults without traditional vascular risk factors often requires a broader differential diagnosis. Pulmonary arteriovenous malformations (PAVMs) are an uncommon but treatable cause of paradoxical embolic stroke. Case Presentation: A previously healthy 40-year-old woman presented to her primary care physician after a several-minute episode of isolated expressive aphasia. She remained fully conscious and understood spoken language but was unable to produce speech despite attempting to articulate words. Neurological examination and non-contrast CT of the head were normal. Approximately one month later, while traveling on a commercial flight, she developed confusion, dysarthria, and unilateral weakness. Repeat CT imaging remained negative, whereas MRI confirmed an acute ischemic stroke. Further evaluation identified a right lower lobe pulmonary arteriovenous malformation, presumed to be the embolic source. She underwent successful transcatheter coil embolization followed by speech and physical therapy with substantial neurological recovery. Conclusion: This case emphasizes that transient isolated aphasia should be managed as a possible TIA even when symptoms have resolved and initial CT imaging is unrevealing. In younger adults with initially cryptogenic stroke, uncommon but treatable embolic sources such as pulmonary arteriovenous malformations should be considered.