Global aphasia without hemiparesis: language profiles and lesion distribution

Objectives-Global aphasia without hemiparesis (GAWH) is an uncommon stroke syndrome involving receptive and expressive language impairment, without th e hemiparesis typically manifested by patients with global aphasia after la rge left perisylvian lesions. A few cases of GAWH have been reported with c onflicting conclusions regarding pathogenesis, lesion localisation, and rec overy. 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 me t criteria for cardioembolic ischaemic stroke. Results-Cluster analysis based on acute language profiles disclosed three s ubtypes of patients with GAWH; these clusters persisted on follow up langua ge assessment. Each cluster evolved into a different aphasia subtype: persi stent GAWH, Wernicke's aphasia, or transcortical motor aphasia (TCM). Compo site lesion analysis showed that persistent GAWH was related to lesioning o f the left superior temporal gyrus. Patients with acute GAWH who evolved in to TCM type aphasia had common lesioning of the left inferior frontal gyrus and adjacent subcortical white matter. Patients with acute GAWH who evolve d into Wernicke's type aphasia were characterised by lesioning of the left precentral and postcentral gyri. Recovery of language was poor in all but o ne patient. Conclusions-Although patients with acute GAWH are similar on neurological e xamination, they are heterogeneous with respect to early aphasia profile, l anguage recovery, and lesion profile.