Global aphasia without hemiparesis: multiple etiologies

Area of Science:

• Neurology
• Stroke Medicine

Background:

• Acute global aphasia without hemiparesis is traditionally considered a hallmark of embolic stroke.
• Identifying the precise etiology is crucial for guiding appropriate patient management and treatment.

Observation:

• Six patients presenting with acute global aphasia without hemiparesis were observed over one year.
• These patients exhibited diverse underlying pathologies, challenging the exclusive association with embolic events.

Findings:

• Two patients experienced multiple strokes, likely embolic.
• Other identified causes included metastases with multiple infarcts, a single middle cerebral artery (MCA) infarct, subarachnoid hemorrhage of unknown origin, and a sylvian fissure hematoma from a ruptured MCA aneurysm.
• These cases highlight that nonembolic etiologies are possible for this clinical presentation.

Implications:

• The findings suggest a need to broaden the differential diagnosis for acute global aphasia without hemiparesis.
• Considering nonembolic causes is vital, especially in patients where anticoagulation is contraindicated.