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MRI scan of case 3 showing left caudate and centrum semiovale infarcts
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Figure 3: MRI scan of case 3 showing left caudate and centrum semiovale infarcts

Mentions: A 55-year-old, right-handed gentleman, chronic smoker and reformed alcoholic hypertensive on treatment, presented with no speech output and an inability to understand others’ speech. Examination revealed an alert but globally aphasic patient with a mild transient right facial paresis lasting less than 24 hours without any limb weakness. CT scan showed infarcts in the head of caudate, anterior limb of internal capsule, external capsule, and the centrum semiovale of the left hemisphere. This was later confirmed by MR imaging [Figure 3]. The cardiac evaluation, carotid and vertebral Doppler and CT angiogram, were normal. The cause of stroke in this patient remained undetermined. At the onset, WAB scores revealed global aphasia. Eight weeks later, the follow-up examination showed improvements in repetition and fluency without noticeable changes in his comprehension skills, leading to a diagnosis of transcortical sensory aphasia.

Global aphasia without hemiparesis: A case series

Pai AR, Krishnan G, Prashanth S, Rao S - Ann Indian Acad Neurol (2011)

Bottom Line: The clinical findings from our subjects showed that GAWH could result from either single/multiple lesions including subcortical lesions.Two cases showed lack of clinico-anatomic correlation during recovery.The recovery pattern may be variable and may show lack of clinico-anatomical correlation indicating anomalous cerebral functional reorganization, questioning the conventional teaching of language representation in the brain.

Affiliation: Department of Neurology, Kasturba Medical College, Manipal College of Allied Health Sciences, Manipal, India.

ABSTRACT

Background: Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the unusual dissociation of motor and language functions. Issues regarding its etio-pathogenesis, lesion sites, and recovery patterns are extensively being debated in contemporary neuroscience literature.

Materials and methods: Four patients admitted in our hospital between 2005 and 2009 with GAWH caused by ischemic stroke were studied retrospectively with emphasis on number and site of lesions, etiology, and recovery patterns.

Results: The clinical findings from our subjects showed that GAWH could result from either single/multiple lesions including subcortical lesions. The recovery was rapid, although not complete. One case evolved into Wernicke's aphasia as seen in earlier studies. Two subjects revealed evolution to transcortical sensory aphasia and one to Broca's aphasia which is distinct from previous proposals. Two cases showed lack of clinico-anatomic correlation during recovery.

Conclusions: GAWH could result from both embolic and large vessel strokes and single or multiple lesions. The recovery pattern may be variable and may show lack of clinico-anatomical correlation indicating anomalous cerebral functional reorganization, questioning the conventional teaching of language representation in the brain.

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