Aphasia in stroke patients: early outcome following thrombolysis

Background: Data on the early course of stroke-related aphasia after thrombolysis are scant. Aims: The aim of this study was to describe recovery patterns of aphasia after thrombolysis in a large sample of stroke patients. Methods & Procedures: Clinical and radiological data of consecutive stroke patients treated with thrombolysis over a 5-year period were routinely entered into prospective registries at two stroke units. Recovery was evaluated using the National Institutes of Health Stroke Scale (NIHSS) at baseline, after 24hr, and on day 7. Aphasia was defined as a score >0 on item 9 of the NIHSS (measurement of language skills), aphasia improvement as any decrease in the item-9 score, and aphasia resolution as an item-9 score of 0. To assess global motor and language impairments, we created a composite language score obtained by summing the scores for items 1b, 1c, and 9; and a composite motor score obtained by summing the scores for items 4, 5, and 6. Outcomes & Results: Out of the 338 patients treated with thrombolysis, 137 (40.5%) had aphasia. In patients with both aphasia and motor deficits (n=109), these two impairments showed similar recovery patterns. Aphasia recovered significantly better in patients without limb motor deficits (n=28) than those with limb motor deficits (n=109), both after 24hr (p<0.05) and after 7days (p<0.0001). These results were supported by findings from a group-based trajectory modelling methods (p<0.005). Conclusions: Language impairments and limb motor deficits show similar recovery after thrombolysis in a given patient. Aphasia recovery is significantly better in the absence of limb motor deficits.