Aphasia during the Acute Phase in Ischemic Stroke

Abstract

Objectives: We investigated the incidence, clinical characteristics, outcome and factors associated with aphasia and early improvement in acute ischemic stroke. Methods: We consecutively studied 855 patients with acute ischemic stroke who were admitted to our hospital within 48 h after onset and who were not comatose on admission. Assessment of aphasia was performed on admission (day 0) and day 10. We examined the incidence, severity, and subtypes of aphasia, and compared the clinical background of patients with and without aphasia on admission, and also those with and without early improvement by day 10. In addition, we investigated the independent factors associated with the presence of aphasia on admission and with early improvement. Results: Of the 855 patients, 130 (15.2%) had aphasia on admission. The National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.21; 95% CI 1.17–1.26) was a significant and independent factor associated with the presence of aphasia on admission. Early improvement was seen in 56 of 121 aphasic patients (46.3%) who were still alive on day 10. A history of hypercholesterolemia (OR 3.27; 95% CI 1.14–9.39) was a significant and independent factor associated with early improvement in aphasia during the acute phase and NIHSS on admission (OR 0.95; 95% CI 0.90–0.99) was marginally significant. Conclusion: It is difficult to predict the outcome of aphasia within the first few days after the onset of ischemic stroke.

Prognosis of aphasia in stroke patients early after iv thrombolysis

“…As shown by Inatomi et al the NIHSS is significantly correlated with the presence of aphasia on admission. 46% of the patients improved after 10 days in a cohort of present in nearly half of our patients and cardioembolism the most common stroke aetiology, this was previously shown in aphasic patients [11].…”

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

“…In regard to the short term, the National Institutes of Health Stroke Scale (NIHSS) 24 , the most widely used scale for thrombolysis evaluation, may display a loss of up to eight points if the patient has global aphasia: two points for level of consciousness questions, two points for level of consciousness commands, one point for sensory loss, and three points for best language. Considering that global aphasia, the most severe aphasic syndrome, is typically the result of large lesions in the middle cerebral artery territory of the dominant hemisphere for language 4 , patients usually lose points for motor items and for dysarthria as well, leading to a probable high score. These facts could partly explain some of the prognostic results we found.…”

“…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 .…”

“…[1] A brief history of the acute symptoms had to be reported by the patient (whenever possible) or a relative, including data on cardiovascular risk factors and socialeducational information, along with a complete neurological exam and a succinct assessment for hearing impairment (listening to finger-scratching with closed eyes, in each ear at once) and visual acuity; [2] Patients were then tested for attentional deficits by means of the "A" Random Letter Test 7 , being required to tap the unimpaired hand on the desk immediately after hearing the letter "A" (75 letters were orally presented by the examiner, 20 of them were "A" letters); [3] Handedness was assessed according to a fivepoint scale of the Edinburgh Inventory 8 for performance in writing, tooth-brushing, catching food with a spoon, opening a box, drawing, using a knife without fork, sweeping the floor (upper hand on the broomstick), throwing a ball, holding scissors, and striking a match; [4] Visual perception was tested by showing the patients ten abstract figures in several levels of difficulty, each of them displayed for ten seconds, soon after which they would have to point to it among four other figures (scored as hit-or-miss) 9 ;…”

Current Evidence for Post Stroke Aphasia Treatment

“…The symptoms of aphasia are various and individualized and involve many aspects of language ability. Prevalence of post-stroke aphasia is variable and it is reported in 15% to 35% of individuals of acute stroke [1]. Lack of functional communication of patients with aphasia results in functional deterioration, poor functional recovery, depression, and increased social isolation.…”