Stroke 2013 July-5

 

Prognosis of aphasia in stroke patients early after iv thrombolysis.

Clin Neurol Neurosurg. 2013 Mar;115(3):289-92.

Kremer C, Perren F, Kappelin J, Selariu E, Abul-Kasim K.

Department of Neurology, Skåne University Hospital, Lund University, Sweden. christine.kremer@skane.se

Abstract

OBJECTIVE: Stroke patients with aphasia have a high long-term morbidity. Intravenous rt-PA (iv) thrombolysis is given more deliberately to these patients. Early outcome data is lacking. Aim of this study was to determine early benefit from rt-PA in patients with aphasia.

METHODS: Data of stroke patients treated by iv thrombolysis was scrutinized for the presence of aphasia defined as ≥1 point for aphasia on the National Institute of Health Stroke Scale (NIHSS). Improvement was defined as a gain of ≥1 point within 24h. Cranial computed tomography (CT) scans were evaluated regarding early ischemic changes (EICs), infarct volume and localization.

RESULTS: Fifty patients with aphasia were included. 16 (32%) of patients improved (4 (36%) minor, 7 (41%) moderate, 5 (23%) major stroke patients), while 44 (62%) remained unchanged. Of 28 patients with EICs, 10 (36%) improved compared to 7 out of 22 (32%) patients without (p=0.773). Aphasia outcome was significantly associated with infarct volume at admission and at 24h (Kruskal-Wallis, p=0.033, p≤0.001, respectively).

CONCLUSION: EICs are not predictive of aphasia outcome and patients with improvement showed smaller infarct volumes. One third improved within 24h, while two thirds remained unchanged. This might justify a closer follow-up of aphasia in stroke patients at the acute stage. Copyright © 2012 Elsevier B.V. All rights reserved.

PMID: 22738732

 

Summary:

Should all patients with aphasia receive thrombolysis?

Aphasia occurs in around one third of stroke patients. Due to its correlation to a significant decrease in quality of life, there has been an increasing tendency towards offering thrombolysis to these patients. There is still little knowledge about the early outcome in patients with aphasia receiving thrombolysis. At the same time recent studies have shown aphasia to spontaneously improve, or even resolve, in a majority of patients with minor stroke in a more long term perspective. Because of this, one can argue that giving thrombolysis to patients with minor stroke, just because of aphasic symptoms, would be unnecessary or even wrong from a risk-benefit point of view. Could there be a way to predict which patients would benefit from thrombolysis?

In our small study of aphasic stroke patients receiving thrombolysis, the short term outcome (symptom status 24 hours after treatment) was investigated and compared to radiographical findings before treatment. The idea was that the occurance of early signs of stroke even before treatment was started would mean a smaller chance of recovery. We found that one third of patients improved in their aphasic symptoms, whereas two thirds were unchanged. However, we could not find a connection between the early signs of stroke found on a CT before treatment and whether or not patients improved in their aphasic symptoms during the first 24 hours after treatment. Because of this it would be reasonable to believe that the radiographical status before treatment should not mean the difference between thrombolysis or not.

 

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