Global Aphasia without Hemiplegia

To the Editor: In his Medical Progress review article on aphasia, Damasio (Feb. 20 issue)¹ stated that the presence of global aphasia without hemiplegia suggests the possibility of an embolic stroke or brain metastases. Although these are the commonest causes of the syndrome, it may also be produced by hemorrhagic stroke,² trauma,^{3 , 4} or nonconvulsive status epilepticus.⁵ Since anticoagulation is often used in patients with embolic stroke, the possibility of a hemorrhagic cause must be considered in patients who present with a stroke-like onset of global aphasia without hemiplegia.