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An unusual case is described of pure meningeal carcinomatosis in the absence of other evidence of tumor occurring 21 years after lobectomy for a localized bronchiolo-alveolar carcinoma. The metastatic disease was confined to the leptomeninges and was documented only by a cisternal cerebrospinal fluid (CSF) examination. Four previous lumbar punctures had shown hypoglycorrachia as the only CSF abnormality.

One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability to read closed-class words (eg, articles, prepositions) with a preserved ability to read open-class words (eg, nouns, verbs). We examined a man with profound Wernicke's aphasia induced by an infarct of the posterior portion of the superior temporal gyrus (Wernicke's area). He could not read substantive words or pronounceable nonwords but could read closed-class words. These observations suggest that the reading of closed- and open-class words is mediated by separable systems. Whereas the anterior perisylvian region appears to be important in reading functional words, the posterior perisylvian region is important in reading substantive words.

If the right hemisphere is dominant for activation and this capacity is critical for normal sexual function, one might expect to find a greater incidence of impaired sexual function after right than after left hemisphere stroke. We found that the prevalence of major sexual dysfunction was significantly greater after right (9/12) than after left (4/14) hemisphere stroke in 26 men with unilateral stroke. These data are consistent with the hypothesis that activation is critical for sexual function as well as the hypothesis that the right hemisphere is dominant for sexual function.

In pure word deafness, comprehension and repetition of speech are impaired, but reading, writing, and spontaneous speech are preserved. Pure word deafness is distinguished from generalized auditory agnosia by the preserved ability to recognize environmental sounds. We examined a patient with pure word deafness associated with bilateral infarctions of the primary auditory cortex, who could use auditory affective intonation to enhance comprehension. The primary auditory cortex seems to be essential for comprehending speech, but comprehension of nonverbal sounds and affective prosody may be mediated by other cerebral structures such as the auditory association cortex.