Clinico-radiological Factors Associated with Aphasia Outcome in Post-stroke Patients: A Prospective Follow Up Study
Rameshwar Chaurasia1, Mukund Agrawal2, Varun Kumar Singh2, Anand Kumar2, Abhishek Pathak2
1Neurology, Institute of Medical Sciences, Banaras Hindu University, 2Neurology, IMS BHU
Objective:
To study the clinical and radiological profile of patients admitted with post stroke aphasia and factors affecting recovery of aphasia
Background:

Aphasia is a language disorder acquired secondary to brain damage. Nearly 21-38% of adult patients admitted to hospital due to stroke have aphasia.

Design/Methods:

We conducted a prospective study of patients with first left Middle Cerebral Artery (MCA)/ Anterior Cerebral Artery (ACA) infarct or Intracerebral Hemorrhage (ICH) admitted within 14 days of stroke onset with Aphasia. Patients with preexisting neuropsychological or speech disorders, cerebellar stroke, bilateral stroke, GCS ≤8 or hemodynamic instability were excluded. Aphasia Quotient was assessed at 2 weeks (AQ1) and 3 months (AQ2) using Western Aphasia Battery-Hindi version. MRI brain with Diffusion Tensor Imaging (DTI) of bilateral Arcuate Fasciculus (AF) and Corticospinal Tract was done at admission, and stroke volume, Laterality Indices of Fractional Anisotropy (LI-FA), Mean Diffusivity (LI-MD), Radial Diffusivity (LI-RD), Axial Diffusivity (LI-AD) and Apparent Diffusion Coefficient (LI-ADC) were obtained.

Results:
36 patients, all right-handed, 8 ICH and 28 Acute Ischemic Stroke (AIS) patients were included. AQ1 and AQ2 were significantly higher in subcortical stroke than cortical. AQ2 and increase in AQ scores (including its sub scores) were significantly higher in ICH than AIS. NIHSS at admission and volume of stroke had significant negative correlation with AQ1 and AQ2. LI-FA (AF) had significant positive correlation with AQ2 (r=0.423) and naming score at 3 months (r=0.447). LI-MD (AF) had significant negative correlation with AQ1 (r=-0.359), AQ2 (r=-0.549) and all subcomponents of AQ2. Significant positive correlation was seen between improvement in mRS and AQ (r=0.395)
Conclusions:

Recovery in language and motor functions occur in parallel simultaneously. Patients at risk of poor language outcomes can be identified with DTI, and active rehabilitation measures can be taken in them.

10.1212/WNL.0000000000204635