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Global aphasia without hemiparesis.

D Tranel, J Biller, H Damasio

    Archives of Neurology
    |March 1, 1987
    PubMed
    Summary
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    Global aphasia without hemiparesis in three patients indicated two distinct left hemisphere lesions. This presentation predicted a notably favorable recovery of speech and language functions.

    Area of Science:

    • Neurology
    • Neuroimaging
    • Cerebrovascular Diseases

    Background:

    • Global aphasia typically presents with right hemiparesis, suggesting a single, large lesion in the dominant left hemisphere.
    • Understanding atypical presentations of global aphasia is crucial for accurate diagnosis and prognosis.

    Observation:

    • Three patients acutely developed global aphasia without the expected right hemiparesis.
    • Neuroimaging revealed two discrete left hemisphere lesions: one in anterior and one in posterior language areas.
    • Cerebral angiography suggested an embolic etiology, with internal carotid artery occlusion or intraluminal clot.

    Findings:

    • The presence of two separate lesions, rather than a single large one, may explain the absence of hemiparesis.
    • This specific lesion pattern (anterior and posterior) appears to be associated with a better prognosis for language recovery.

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    Implications:

    • Global aphasia without hemiparesis may indicate a distinct pathophysiological mechanism and a more favorable outcome.
    • These findings challenge the traditional understanding of lesion localization for global aphasia and highlight the importance of detailed neuroimaging.
    • Further research into the neuroplasticity and recovery patterns associated with dual-lesion aphasia is warranted.