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Mild traumatic brain injury (MTBI) and postconcussive syndrome can result in difficult to document complaints regarding subtle language use. Narrative discourse production has been shown to be a sensitive index of linguistic and cognitive deficits in the more severe TBI population. The narrative discourse production of MTBI subjects was investigated to determine whether cognitive changes were reflected in linguistic production. Eight MTBI, five moderate TBI, and five neurologically normal subjects were matched for age, education, and gender. The TBI subjects were matched on a number of neuropsychological measures. The subjects produced narratives about their correct picture sequences on five items from the Wechsler Adult Intelligence Scale-Revised picture arrangement subtest. The narratives were scored for correct arrangement, content essential information, correct story, and implied meaning. Significant differences were found between the normal control group and both the TBI groups on accuracy of narrative description of the correct picture sequences. Although differences in generation of implied meaning failed to reach significance, a trend was noted for both the TBI groups to produce fewer implied meanings than the control group. The results suggest that cognitive disruptions associated with MTBI may affect the quality of narrative discourse.

Episodic memory performance was improved in the galantamine treatment group but did not improve in the placebo group. In contrast, performance on 2 of the processing speed measures showed significant improvement in the placebo condition, whereas that of the patients treated with galantamine did not improve. Galantamine may thus have specific benefits for episodic memory, but not processing speed, in patients with cognitive impairment as part of bipolar disorder.

Objectives-Global aphasia without hemiparesis (GAWH) is an uncommon stroke syndrome involving receptive and expressive language impairment, without the hemiparesis typically manifested by patients with global aphasia after large left perisylvian lesions. A few cases of GAWH have been reported with conflicting conclusions regarding pathogenesis, lesion localisation, and recovery. The current study was conducted to attempt to clarify these issues. Methods-Ten cases of GAWH were prospectively studied with language profiles and lesion analysis; five patients had multiple lesions, four patients had a single lesion, and one had a subarachnoid haemorrhage. Eight patients met criteria for cardioembolic ischaemic stroke. Results-Cluster analysis based on acute language profiles disclosed three subtypes of patients with GAWH; these clusters persisted on follow up language assessment. Each cluster evolved into a different aphasia subtype: persistent GAWH, Wernicke's aphasia, or transcortical motor aphasia (TCM). Composite lesion analysis showed that persistent GAWH was related to lesioning of the left superior temporal gyrus. Patients with acute GAWH who evolved into TCM type aphasia had common lesioning of the left inferior frontal gyrus and adjacent subcortical white matter. Patients with acute GAWH who evolved into Wernicke's type aphasia were characterised by lesioning of the left precentral and postcentral gyri. Recovery of language was poor in all but one patient. Conclusions-Although patients with acute GAWH are similar on neurological examination, they are heterogeneous with respect to early aphasia profile, language recovery, and lesion profile. (J Neurol Neurosurg Psychiatry 1999;66:365-369)

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