Abstract We report on a case study of a Spanish-Basque bilingual with aphasia. Our aim is to explore the (dis)similarities between symptoms across linguistic components to see whether the impairment affects the two languages similarly, and whether the structural distance between these languages may influence the (dis)similarities found and the cross-linguistic pattern. Qualitative similarities in lexical and phonological impairments point towards cross-linguistic transfer of therapy benefits due to the typological proximity of the Spanish and Basque lexicon (cognates) and phonological systems. However, qualitative differences in comprehension make it difficult to sustain any cross-linguistic influence, which might be hindered by the structural distance between the morphosyntactic features of Spanish and Basque. Finally, the pattern of impairment observed supports the neurofunctional distinction of languages in bilinguals.