J Stroke Cerebrovasc Dis. 2012 Jul;21(5):350-7. doi: 10.1016/j.jstrokecerebrovasdis.2010.09.009. Epub 2010 Dec 24.
The prognosis for aphasia in stroke.
Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, Harris GJ, Halpern EF, Koroshetz WJ, Furie KL.
SourceDepartment of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. firstname.lastname@example.org
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 6="" 90="" and="" aphasia="" associated="" better="" by="" clinically="" disability.="" factors="" in="" included="" lower="" months.="" of="" outcome="" p="" prestroke="" radiographically="" resolved="" significantly="" smaller="" strokes="" subjects="" with="">
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.
Copyright © 2012 National Stroke Association. All rights reserved.5>
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