BACKGROUND: Aphasia is a disabling chronic stroke symptom, but the prognosis for patients presenting with aphasia in the hyperacute window has not been well characterized. The purpose of this study is to assess the prognosis for recovery of language function in subjects presenting with aphasia caused by ischemic stroke within 12 hours of symptom onset. METHODS: Subjects presenting with aphasia were identified from a prospective cohort study of 669 subjects presenting emergently with acute stroke. Subjects were characterized by demographics, serial clinical examinations, unenhanced computed tomography, and computed tomographic angiography. Aphasia severity was assessed by National Institutes of Health Stroke Scale (NIHSS) examinations performed at baseline, discharge, and 6 months. Demographic, clinical, and imaging factors were assessed for prognostic impact. RESULTS: Aphasia was present in 30% of subjects (n = 204). Of the 166 aphasic patients alive at discharge (median 5 days), aphasia improved in 57% and resolved in 38%. In the 102 aphasic subjects evaluated at 6 months, aphasia improved in 86% and completely resolved in 74% of subjects. Among aphasic subjects with "mild" stroke (initial NIHSS <5), aphasia resolved in 90% of subjects by 6 months. Factors significantly associated with better outcome included clinically and radiographically smaller strokes and lower prestroke disability. CONCLUSIONS: The prognosis for full recovery of aphasia present in the hyperacute window is good. Radiographic and clinical markers indicating lesser extent of ischemia correlated to greater recovery. Given the excellent prognosis for language recovery in mild stroke, the net benefit of thrombolysis in such cases is uncertain.
BACKGROUND:Aphasia is a disabling chronic stroke symptom, but the prognosis for patients presenting with aphasia in the hyperacute window has not been well characterized. The purpose of this study is to assess the prognosis for recovery of language function in subjects presenting with aphasia caused by ischemic stroke within 12 hours of symptom onset. METHODS: Subjects presenting with aphasia were identified from a prospective cohort study of 669 subjects presenting emergently with acute stroke. Subjects were characterized by demographics, serial clinical examinations, unenhanced computed tomography, and computed tomographic angiography. Aphasia severity was assessed by National Institutes of Health Stroke Scale (NIHSS) examinations performed at baseline, discharge, and 6 months. Demographic, clinical, and imaging factors were assessed for prognostic impact. RESULTS:Aphasia was present in 30% of subjects (n = 204). Of the 166 aphasic patients alive at discharge (median 5 days), aphasia improved in 57% and resolved in 38%. In the 102 aphasic subjects evaluated at 6 months, aphasia improved in 86% and completely resolved in 74% of subjects. Among aphasic subjects with "mild" stroke (initial NIHSS <5), aphasia resolved in 90% of subjects by 6 months. Factors significantly associated with better outcome included clinically and radiographically smaller strokes and lower prestroke disability. CONCLUSIONS: The prognosis for full recovery of aphasia present in the hyperacute window is good. Radiographic and clinical markers indicating lesser extent of ischemia correlated to greater recovery. Given the excellent prognosis for language recovery in mild stroke, the net benefit of thrombolysis in such cases is uncertain.
Authors: T Brott; H P Adams; C P Olinger; J R Marler; W G Barsan; J Biller; J Spilker; R Holleran; R Eberle; V Hertzberg Journal: Stroke Date: 1989-07 Impact factor: 7.914
Authors: Hakan Ay; Karen L Furie; Aneesh Singhal; Wade S Smith; A Gregory Sorensen; Walter J Koroshetz Journal: Ann Neurol Date: 2005-11 Impact factor: 10.422
Authors: David T Winkler; Felix Fluri; Peter Fuhr; Stephan G Wetzel; Philippe A Lyrer; Stephan Ruegg; Stefan T Engelter Journal: Stroke Date: 2009-01-22 Impact factor: 7.914
Authors: Hanane El Hachioui; Hester F Lingsma; Mieke E van de Sandt-Koenderman; Diederik W J Dippel; Peter J Koudstaal; Evy G Visch-Brink Journal: J Neurol Date: 2012-07-22 Impact factor: 4.849
Authors: Joseph C Griffis; Rodolphe Nenert; Jane B Allendorfer; Jennifer Vannest; Scott Holland; Aimee Dietz; Jerzy P Szaflarski Journal: Hum Brain Mapp Date: 2016-12-16 Impact factor: 5.038
Authors: Stephen M Wilson; Dana K Eriksson; Temre H Brandt; Sarah M Schneck; Jillian M Lucanie; Annie S Burchfield; Sara Charney; Ian A Quillen; Michael de Riesthal; Howard S Kirshner; Pélagie M Beeson; Leslie Ritter; Chelsea S Kidwell Journal: J Speech Lang Hear Res Date: 2019-03-25 Impact factor: 2.297
Authors: Alexandra Basilakos; Brielle C Stark; Lisa Johnson; Chris Rorden; Grigori Yourganov; Leonardo Bonilha; Julius Fridriksson Journal: Neurorehabil Neural Repair Date: 2019-07-17 Impact factor: 3.919