Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Md 21287, USA.
Stroke. 2010 Feb;41(2):325-30. doi: 10.1161/STROKEAHA.109.570374. Epub 2009 Dec 31.
We aimed to determine if ischemia involving Broca area predicts Broca aphasia more reliably in acute or chronic stroke.
We included consecutive right-hand-dominant patients with left hemisphere ischemic stroke (<48 hours from onset for acute stroke or >6 months after stroke for chronic stroke). MRI scans were analyzed for ischemic lesions or hypoperfusion in Broca area (Brodmann areas 44 and 45). Patients were scored on the Western Aphasia Battery to classify aphasia syndromes; chi(2) tests were used to identify significant associations.
The presence of infarct involving any part of Broca area and the presence of Broca or global aphasia was much stronger in acute (chi(2)=38.1; df1; P<0.0001) than in chronic stroke (chi(2)=0.54; df1; P=0.46; not significant). The association between infarct or hypoperfusion covering all of Broca area and the presence of Broca or global aphasia was much stronger in acute (chi(2)=35.8; df1; P<0.0001) than in chronic stroke (chi(2)=1.2; df1; p=0.27; not significant). In a subset of 20 patients studied longitudinally, the associations were significant only acutely, not chronically (chi(2)=20; df1; P<0.0001 vs. chi(2)=0; df1; p=1; not significant for ischemia involving part of Broca area, and chi(2)=16.4; df1; P<0.0001 vs chi(2)=3.2; df1; p=0.08; not significant for ischemia covering all of Broca area).
Broca aphasia is more reliably associated with infarct/ hypoperfusion of Broca area in acute stroke. Many chronic stroke patients with damage to part or all of Broca area had neither Broca nor global aphasia. Broca or global aphasia was sometimes present initially in these patients but resolved by 6 months. Our results indicate that the acute aphasia syndrome may allow the clinician to predict the compromised vascular territory, even when structural imaging shows only a small (or no) infarct.
我们旨在确定 Broca 区的缺血是否能更可靠地预测急性或慢性卒中后的 Broca 失语症。
我们纳入了连续的优势侧为左手的左半球缺血性卒中患者（急性卒中发病后<48 小时或慢性卒中后>6 个月）。分析磁共振成像扫描以确定 Broca 区（Brodmann 区 44 和 45）的缺血性病变或低灌注。患者用西方失语症成套测验进行评分以分类失语症综合征；卡方检验用于确定显著相关性。
在急性卒中（卡方=38.1；df1；P<0.0001）中，Broca 区任何部位梗死的存在以及 Broca 或完全性失语症的存在，明显强于慢性卒中（卡方=0.54；df1；P=0.46；不显著）。在急性卒中（卡方=35.8；df1；P<0.0001）中，Broca 区全部梗死或低灌注与 Broca 或完全性失语症的存在之间的相关性明显强于慢性卒中（卡方=1.2；df1；P=0.27；不显著）。在 20 例进行纵向研究的患者亚组中，仅在急性时存在相关性，慢性时无相关性（卡方=20；df1；P<0.0001 与卡方=0；df1；P=1；不显著，Broca 区部分梗死；卡方=16.4；df1；P<0.0001 与卡方=3.2；df1；P=0.08；Broca 区全部梗死不显著）。
Broca 失语症与急性卒中时的 Broca 区梗死/低灌注更可靠相关。许多慢性卒中患者的 Broca 区部分或全部受损，但既无 Broca 性也无完全性失语症。这些患者的 Broca 性或完全性失语症有时起初存在，但在 6 个月时已缓解。我们的结果表明，急性失语症综合征可能使临床医生能够预测血管受累区域，即使结构影像学检查仅显示小（或无）梗死。
