Factors Influencing Aphasia Outcome in Patients with Occlusive Stroke
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- Category: Vol. 87, September 2019
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Factors Influencing Aphasia Outcome in Patients with Occlusive Stroke, ESAM M. ELSHAZLY, OSAMA A. RAGAB, AYMAN M. ALMALT, DINA M. MOHAMED, AHMED M. ELSHAMY and EHAB S. MOHAMMED
Abstract
Background: Aphasia related to ischemic stroke is a major health problem affecting the quality of life profoundly.
Aim of Study: Is to assess factors influencing aphasia outcome in patients with occlusive stroke and the role of functional magnetic resonance imaging in detection the patterns of post-stroke language recovery.
Patients and Methods: This was a prospective cohort study done at Neuropsychiatry Department and Center of Psychiatry, Neurology and Neurosurgery, Diagnostic Radiol-ogy, Tanta University, from January 2017 to January 2018. Aphasia Rapid Test (ART) at day 1 and follow-up at day 8 which is a bed side clinical test to assess aphasia severity, Diffusion Tensor Imaging (DTI) and fMRI were done at day 8 to assess aphasia severity. A total of 34 cases were finally included in this study after fulfilling the inclusion and exclusion criteria, 12 patients who had receptive or global aphasia, were not suitable for fMRI, their native language Arabic, age <80 years.
Results: The total number of the studied patients was 34 of them 18 patients (52.9%) were males and 16 patients were females (47.1%). The age of the studied patients ranged from 28-79 years. The older group of patients had severe language disability also those with global aphasia and perisylvian lesion, risk factors as HTN, DM, Cardiac Disease, Dyslipidemia had worse prognosis, those with no reconstruction of the Arcuate Fasiculus in DTI and fMRI data analysis showed negative effect of the site contralateral to lesion.
Conclusion: Age was a significant factor with the higher age group had the worst prognosis regarding aphasia. Large lesion sizes and those with damage to strategic language areas had a bad prognosis. fMRI and DTI were the cornerstone of our study and they were a highly reliable tools in the prognosis of language outcome, with those who had activity in the perilesional and bilateral activity (perilesional and contralateral homotopic) in fMRI to have better outcome than those with only contralateral activity, also DTI to delineate the AF and the degree of its integrity and reconstitution.