Paolo Manganotti1, Giovanni Furlanis2, Miloš Ajčević3, Paola Polverino2, Paola Caruso2, Mariana Ridolfi2, Roberta Antea Pozzi-Mucelli4, Maria Assunta Cova4, Marcello Naccarato2. 1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di fiume, 447 - 34149, Trieste, Italy. Electronic address: pmanganotti@units.it. 2. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di fiume, 447 - 34149, Trieste, Italy. 3. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di fiume, 447 - 34149, Trieste, Italy; NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy. 4. Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di fiume, 447 - 34149, Trieste, Italy.
Abstract
PURPOSE: Isolated speech impairment is one of the most challenging clinical manifestations of stroke mimic (SM). We aimed to investigate perfusional and EEG pattern of isolated aphasia to better differentiate between vascular and epileptic etiology in emergency settings. METHOD: We retrospectively analyzed 481 cases with acute focal neurological symptoms admitted to our Stroke Unit. The patients showing isolated aphasia and confirmed ischemic infarction or SM with seizure etiology on follow-up were included for subsequent analysis of clinical, neuroimaging, and EEG data. We investigated differences in CT Perfusion maps between ROI in the anatomical area compatible with clinical presentation, contralateral ROI and EEG in order to evaluate perfusion and brain oscillatory activity abnormalities. RESULTS: 45 patients presented isolated aphasia as principal neurological symptom: 27 cases due to acute ischemic event, 11 due to seizure SM, while 7 were SM due to other etiologies. Out of 11 SM patients with seizure etiology, significant hyperperfusion on CTP maps (MTT AI%<-10%) and sharp EEG waves were observed in 8 patients, while in 3 patients slight hypoperfusion (MTT AI%<20%) and slow EEG rhythms were detected. 24 out of 27 ischemic stroke patients presented severe hypoperfusion with MTT AI above the stroke threshold (MTT AI > 45%). All ischemic stroke patients presented slower EEG rhythms. CONCLUSIONS: The main finding of this study is the identification of different clinical and neuroimaging patterns of isolated aphasia with epileptic or ischemic etiology in emergency settings.
PURPOSE: Isolated speech impairment is one of the most challenging clinical manifestations of stroke mimic (SM). We aimed to investigate perfusional and EEG pattern of isolated aphasia to better differentiate between vascular and epileptic etiology in emergency settings. METHOD: We retrospectively analyzed 481 cases with acute focal neurological symptoms admitted to our Stroke Unit. The patients showing isolated aphasia and confirmed ischemic infarction or SM with seizure etiology on follow-up were included for subsequent analysis of clinical, neuroimaging, and EEG data. We investigated differences in CT Perfusion maps between ROI in the anatomical area compatible with clinical presentation, contralateral ROI and EEG in order to evaluate perfusion and brain oscillatory activity abnormalities. RESULTS: 45 patients presented isolated aphasia as principal neurological symptom: 27 cases due to acute ischemic event, 11 due to seizure SM, while 7 were SM due to other etiologies. Out of 11 SM patients with seizure etiology, significant hyperperfusion on CTP maps (MTT AI%<-10%) and sharp EEG waves were observed in 8 patients, while in 3 patients slight hypoperfusion (MTT AI%<20%) and slow EEG rhythms were detected. 24 out of 27 ischemic strokepatients presented severe hypoperfusion with MTT AI above the stroke threshold (MTT AI > 45%). All ischemic strokepatients presented slower EEG rhythms. CONCLUSIONS: The main finding of this study is the identification of different clinical and neuroimaging patterns of isolated aphasia with epileptic or ischemic etiology in emergency settings.
Authors: Antonio Granato; Laura D'Acunto; Miloš Ajčević; Giovanni Furlanis; Maja Ukmar; Roberta Antea Pozzi Mucelli; Paolo Manganotti Journal: Neurol Sci Date: 2020-05-26 Impact factor: 3.307
Authors: J L Restrepo-Vera; P Coscojuela; E Fonseca; M Quintana; S Sarria-Estrada; E Santamarina; L Abraira; M Sueiras; V Thonon; J Álvarez-Sabin; M Toledo; A Rovira Journal: J Neurol Date: 2022-02-13 Impact factor: 4.849
Authors: Miloš Ajčević; Giovanni Furlanis; Aleksandar Miladinović; Alex Buoite Stella; Paola Caruso; Maja Ukmar; Maria Assunta Cova; Marcello Naccarato; Agostino Accardo; Paolo Manganotti Journal: Ann Biomed Eng Date: 2021-02-18 Impact factor: 3.934