If the cerebral cortex is involved, the central nervous system pathways can again be affected, but can also produce the following symptoms:

• aphasia (difficulty with verbal expression, auditory comprehension, reading and writing; Broca's or Wernicke's area typically involved)
• dysarthria (motor speech disorder resulting from neurological injury)
• apraxia (altered voluntary movements)
• visual field defect
• memory deficits (involvement of temporal lobe)
• hemineglect (involvement of parietal lobe)
• disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe)
• lack of insight of his or her, usually stroke-related, disability