PT  - JOURNAL ARTICLE
AU  - Robert E Hanlon
AU  - Warren E Lux
AU  - Alexander W Dromerick
TI  - Global aphasia without hemiparesis: language profiles and lesion distribution
AID  - 10.1136/jnnp.66.3.365
DP  - 1999 Mar 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 365--369
VI  - 66
IP  - 3
4099  - http://jnnp.bmj.com/content/66/3/365.short
4100  - http://jnnp.bmj.com/content/66/3/365.full
SO  - J Neurol Neurosurg Psychiatry1999 Mar 01; 66
AB  - OBJECTIVES Global aphasia without hemiparesis (GAWH) is an uncommon stroke syndrome involving receptive and expressive language impairment, without the hemiparesis typically manifested by patients with global aphasia after large left perisylvian lesions. A few cases of GAWH have been reported with conflicting conclusions regarding pathogenesis, lesion localisation, and recovery. The current study was conducted to attempt to clarify these issues. METHODS Ten cases of GAWH were prospectively studied with language profiles and lesion analysis; five patients had multiple lesions, four patients had a single lesion, and one had a subarachnoid haemorrhage. Eight patients met criteria for cardioembolic ischaemic stroke. RESULTS Cluster analysis based on acute language profiles disclosed three subtypes of patients with GAWH; these clusters persisted on follow up language assessment. Each cluster evolved into a different aphasia subtype: persistent GAWH, Wernicke’s aphasia, or transcortical motor aphasia (TCM). Composite lesion analysis showed that persistent GAWH was related to lesioning of the left superior temporal gyrus. Patients with acute GAWH who evolved into TCM type aphasia had common lesioning of the left inferior frontal gyrus and adjacent subcortical white matter. Patients with acute GAWH who evolved into Wernicke’s type aphasia were characterised by lesioning of the left precentral and postcentral gyri. Recovery of language was poor in all but one patient. CONCLUSIONS Although patients with acute GAWH are similar on neurological examination, they are heterogeneous with respect to early aphasia profile, language recovery, and lesion profile.