Global aphasia without hemiparesis: multiple etiologies

Acute global aphasia without hemiparesis has been considered pathognomonic of embolic stroke. During 1 year, we encountered six patients with this syndrome. Two had multiple strokes, probably embolic. One had atrial fibrillation; at autopsy, there were metastases as well as multiple infarcts in the left hemisphere. One had a single large infarct in the territory of an anterior branch of the middle cerebral artery (MCA), one had subarachnoid hemorrhage of unknown origin, and one had a sylvian fissure hematoma with intraparenchymal extension from a ruptured MCA aneurysm. Nonembolic etiologies are therefore also possible and include conditions that bar anticoagulation.