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. 2012 Jul;21(5):350-7.
doi: 10.1016/j.jstrokecerebrovasdis.2010.09.009. Epub 2010 Dec 24.

The prognosis for aphasia in stroke

Matthew B Maas  1 , Michael H Lev, Hakan Ay, Aneesh B Singhal, David M Greer, Wade S Smith, Gordon J Harris, Elkan F Halpern, Walter J Koroshetz, Karen L Furie
Affiliations

The prognosis for aphasia in stroke

Matthew B Maas et al. J Stroke Cerebrovasc Dis. 2012 Jul.

Abstract

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.

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Conflict of interest statement

Conflicts of Interest/Disclosures:

Matthew B. Maas, MD- none.

Michael H. Lev, MD- is a speaker for GE Healthcare, Waukesha, WI; receives research support from GE Healthcare; and serves as a consultant for CoAxia, Maple Grove, MN, GE Healthcare, Waukesha, WI and Millennium Pharmaceuticals, Cambridge, MA.

Hakan Ay, MD- none.

Aneesh B. Singhal, MD- none.

David M. Greer, MD, MA- has served on the speaker's bureau for Boehringer-Ingelheim Pharmaceuticals, Ridgefield, CT.

Wade S. Smith, MD, PhD- owns stock and has stock options in Concentric Medical, Inc., Mountain View, CA, is a paid consultant for Concentric Medical, Inc., and has a research grant from Boerhinger-Ingelheim Pharmaceuticals, Ridgefield, CT.

Gordon J. Harris, PhD- none.

Elkan F. Halpern, PhD- none.

Walter J. Koroshetz, MD- none.

Karen L. Furie, MD, MPH- none.

Figures

Figure 1
Figure 1
Study Flow Diagram
See this image and copyright information in PMC

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