Aphasia in acute stroke.

Abstract

Previous surveys of stroke populations have offered only cursory information on language disturbance, and, conversely, few surveys of aphasic populations have dealth exclusively with stroke or with acute phenomena. This paper describes aphasia in 850 acute stroke patients consecutively registered by the Harlem Regional Stroke Program, of whom 177 (21%) were aphasic; of these, nine were of Broca's type, 24 were of Wernicke's type, 14 were of anomic, ten were conduction, seven were of "isolation" type, and 107 were "mixed." An unexpected finding was a significant over-representation of men among the nonfluent aphasics. During the following four to 12 weeks, 12% of fluent aphasics died, and 12% remained moderately or severely impaired; among survivors, aphasia improved in 74%, and in 44% it cleared completely. During the same period, 32% of nonfluent aphasics died, and 34% remained moderately or severely impaired; among survivors, aphasia improved in 52%, and in only 13% did it clear completely. In both fluent and nonfluent groups, hemiparesis and/or visual field cut were associated with poor prognosis.

Sex Differences in Functional Brain Asymmetry

“…As mentioned earlier, 6 men and 2 women were untestable on intellectual measures because of severe language difficulties. This sex ratio agrees with recent findings suggesting a higher incidence of aphasia in males after cerebral lesions [10]. To examine whether the lowered Verbal IQ seen in the 23 men with left-sided lesions was related to a greater degree of dysphasia than in their female counterparts, more basic measures of speech production were taken.…”

Vascular Aphasias

“…1 Among cognitive deficits, aphasia is observed with a frequency ranging from 21% to 38% at the acute stage, [2][3][4] and stroke accounts for Ϸ80 000 new cases of aphasia annually in the United States. 5 The presence of aphasia is an index of poor prognosis, with more severe motor, cognitive, and social disability 1,3,6 and higher mortality.…”

“…Second, studies focusing on vascular aphasia have included either selected samples with extensive evaluation of language 1,8,9 or large series of consecutive patients examined with shortened testing. [2][3][4][5][6][7][8][9][10] Although the latter studies provide important findings, they usually focus on oral expression and do not determine the type of language disorder. This leads to confounding of very different disorders such as dysarthria and aphasia, or Broca's and global aphasias, which have different severities and outcomes.…”

“…[11][12][13][14] This suggests that other factors influence clinical outcome. A few studies have suggested age and sex, with a higher frequency of nonfluent aphasia in young patients, 10,15-17 a lower frequency of aphasia in women, 2,18 and a better outcome in young patients. 17,19,20 These results have been obtained in series of selected patients and were not replicated in other studies.…”

Reduced Diffusion Tensor Fractional Anisotropy in the Left Arcuate Fasciculus of Patients with Aphasia Caused by Acute Cerebral Infarct

“…Subtypes of aphasia (e.g., total, motor, sensory, conduction, and transcortical) were further diagnosed in reference to the patients' abilities with respect to spontaneous speech, hearing/comprehension, naming, and repetition. 20) Patients with aphasia sometimes exhibit coexisting limb apraxia. 21) Because the neural deficits underlying these comorbidities could complicate analysis, we carefully observed patients during daily activities at the bedside.…”