Short-term prognosis for speech and language in first stroke patients

Abstract

-Objective: To evaluate the factors that can influence evolution of communication after a first stroke. Method: Thirty-seven adult patients were evaluated for speech and language within 72 hours after a single first-ever ischemic brain injury and later on. Patients who were comatose, with decompensated systemic diseases, or history of chronic alcoholism or illicit drug use were not included. Brain CT and/or 2T-MR exams were solicited for topographic correlation. Size of infarct was classified as large or small according to the TOAST classification. Results: Patients who survived had lesser chances of presenting with aphasia or dysarthria 3 months after the stroke if the infarct size was small (p=0.017). Gender, age, schooling, aphasia subtype, infarct side and topography were non-significant in our sample. Subjects with global aphasia or lone cortical dysarthria had a slower evolution. Conclusion: Brain injury size was the most influential factor for neurological outcome at 3 months post-stroke.Key WORdS: linguistics, stroke, brain infarction, language, speech, disability evaluation, prognosis. Prognóstico em curto prazo para fala e linguagem em pacientes acometidos de infarto cerebral únicoResumo -Objetivo: Avaliar os fatores que podem influenciar o desempenho neurolinguístico após um primeiro acidente vascular cerebral isquêmico. Método: Foram avaliados 37 pacientes quanto a fala e linguagem dentro de 72 horas após um primeiro infarto cerebral e posteriormente. Pacientes comatosos, com doenças sistêmicas descompensadas, história de etilismo crônico ou uso de drogas ilícitas não foram incluídos. TC e/ou RMN-2T cerebrais foram solicitadas para correlação topográfica. Utilizou-se a classificação TOAST para o tamanho do infarto (grande ou pequeno). Resultados: Sobreviventes tiveram menores chances de apresentarem-se afásicos ou disártricos 3 meses após o evento agudo caso o infarto fosse pequeno (p=0.017). Gênero, idade, escolaridade, subtipo de afasia, lado e topografia da lesão cerebral não foram fatores estatisticamente significativos. Pacientes portadores de afasia global ou disartria cortical isolada evoluíram mais lentamente. Conclusão: O tamanho da lesão cerebral foi o fator mais influente para o desempenho neurolinguístico 3 meses após o evento agudo.PAlAvRAS-ChAve: linguística, acidente cerebral vascular, infarto encefálico, linguagem, fala, avaliação da deficiência, prognóstico.

Global aphasia as a predictor of mortality in the acute phase of a first stroke

“…Prognosis for speech and language in acute stroke is hard to quantify 4,6,30 . Patients with nonfluent aphasias may evolve to fluent forms 5,6 , but when global aphasia is present in the acute stroke phase and does not completely resolve, a predominant loss of fluency is often observed 6 .…”

“…Patients with nonfluent aphasias may evolve to fluent forms 5,6 , but when global aphasia is present in the acute stroke phase and does not completely resolve, a predominant loss of fluency is often observed 6 . Interobserver agreement is usually lower among patients assessed very early and very late after symptom onset.…”

A topographic study on the evaluation of speech and language in the acute phase of a first stroke

“…Most patients with aphasia changed to a less disabling form of language impairment during follow-up. A non-fluent aphasia could evolve into a fluent form of aphasia, whereas expectedly the opposite never occurred 7,19,20 . All but two patients with global aphasia had large lesions in the left MCA territory, for this was the lesion site that affected most language functions.…”

“…Four of the eight patients who did not survive had a cardioembolic stroke, while cardioembolism was the most frequent etiology for patients with global (5) Spontaneous speech* -5 5 14 2 0.0001 (6) Counting from 1 to 20* -4 2 11 1 0.0120 (6) Mentioning the 7 weekdays* -3 3 10 0 0.0046 (6) Singing* -3 4 12 0 0.0001 (6) Phono-articulatory function* -0 4 4 7 0.0043 (6) Constructional praxis (4 matches)* -3 2 14 4 0.0021 (6) Constructional praxis (9 matches)* -2 4 14 6 0.0105 (6) Ideomotor praxis (mean±SD) 5 2.8±1.6 2.4±1.5 1.6±2.0 4.7±0.5 0.0012 (7) SD: standard deviation; MCA: middle cerebral artery. *Number of subjects with difficulties and/or errors; (1) ANOVA; (2) ANOVA followed by Tukey's test (differences between the following groups: capsule-nuclear and whole middle cerebral artery territory; capsule-nuclear and temporal-parietal; capsulenuclear and frontal); (3) ANOVA followed by Tukey's test (differences between the following groups: frontal and temporal-parietal; frontal and whole middle cerebral artery territory; capsule-nuclear and temporal-parietal; capsule-nuclear and whole middle cerebral artery territory); (4) ANOVA followed by Tukey's test (differences between the capsule-nuclear group and the whole middle cerebral artery territory group); (5) ANOVA followed by Tukey's test (differences between the following groups: capsule-nuclear and whole middle cerebral artery territory; capsule-nuclear and frontal); (6) Fisher's exact test; (7) ANOVA followed by Tukey's test (differences between the following groups: capsule-nuclear and temporal-parietal; capsule-nuclear and whole middle cerebral artery territory).…”

“…The examiner was blind to the neuroimaging localization diagnosis during the assessment 7 , which consisted on a short medical interview with a complete neurological exam including visual acuity and hearing evaluation (listening to finger-scratching with closed eyes, in each ear at once), and also the following cognitive and linguistic tasks:…”