Aphasia is a frequent reason for consultation in emergency departments, especially in neurology-specialized units. Although stroke is usually the most common cause, isolated presentations broaden the differential diagnosis to include other etiologies

To identify clinical and demographic predictors at consultation that may guide diagnosis toward the underlying etiology in patients presenting with acute aphasia.

Retrospective analysis of emergency room consultation records from January 2019 to December 2023 using the keywords “aphasia,” “language disorder,” and “language difficulty.” 

Adults symptomatic at consultation, examined by a neurologist, with at least one follow-up were included. Individuals with subacute/chronic course or middle cerebral artery syndrome were excluded. 

Demographics, cardiovascular risk factors, previous aphasia, cerebrovascular events, epilepsy, aphasia type, and severity were recorded.

Diagnosis was supported by neuroimaging, electroencephalogram, clinical features, and follow-up. Analyses for this study were restricted to vascular and epileptic etiologies. Odds ratio (OR) and relative risk (RR) were calculated; values >1 suggested vascular etiology. Significance was defined as p < 0.05.

Of 795 patients with acute aphasia, 130 were classified as epileptic or vascular.

Median age was higher in the vascular group (74.6 ± 11.8 vs 66.3 ± 17.2, p 0.010). Previous aphasia, history of epilepsy, and brain tumors were associated with epilepsy (p<0.05). Cardiovascular risk factors, headache, and other neurological deficits were more common in stroke, though not statistically significant.

Global aphasia was more frequent in epilepsy group (n: 66 vs 25, OR 0.25, p 0.0003); however, statistical significance decreased in patients with associated motor symptoms (OR 0.5, p 0.25). Mild motor aphasia was associated with stroke (OR 3.55, p 0.005).

Acute isolated global aphasia strongly correlates with epileptic etiology. This is the first study evaluating the type and severity of acute language impairment as predictor of underlying cause. Considering the risk of sequelae that stroke encompasses, further studies are needed.