Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Stroke Cerebrovasc Dis. 2012 Jul;21(5):350-7. doi: 10.1016/j.jstrokecerebrovasdis.2010.09.009. Epub 2010 Dec 24.
Aphasia is a disabling chronic stroke symptom, but the prognosis for patients presenting with aphasia in the hyperacute window has not been well characterized. The purpose of this study is to assess the prognosis for recovery of language function in subjects presenting with aphasia caused by ischemic stroke within 12 hours of symptom onset.
Subjects presenting with aphasia were identified from a prospective cohort study of 669 subjects presenting emergently with acute stroke. Subjects were characterized by demographics, serial clinical examinations, unenhanced computed tomography, and computed tomographic angiography. Aphasia severity was assessed by National Institutes of Health Stroke Scale (NIHSS) examinations performed at baseline, discharge, and 6 months. Demographic, clinical, and imaging factors were assessed for prognostic impact.
Aphasia was present in 30% of subjects (n = 204). Of the 166 aphasic patients alive at discharge (median 5 days), aphasia improved in 57% and resolved in 38%. In the 102 aphasic subjects evaluated at 6 months, aphasia improved in 86% and completely resolved in 74% of subjects. Among aphasic subjects with "mild" stroke (initial NIHSS <5), aphasia resolved in 90% of subjects by 6 months. Factors significantly associated with better outcome included clinically and radiographically smaller strokes and lower prestroke disability.
The prognosis for full recovery of aphasia present in the hyperacute window is good. Radiographic and clinical markers indicating lesser extent of ischemia correlated to greater recovery. Given the excellent prognosis for language recovery in mild stroke, the net benefit of thrombolysis in such cases is uncertain.
失语症是一种使人丧失能力的慢性中风症状，但超急性期出现失语症的患者的预后尚未得到很好的描述。本研究旨在评估在症状发作后 12 小时内出现缺血性中风导致的失语症患者语言功能恢复的预后。
从一项 669 例急性中风急诊患者的前瞻性队列研究中确定出现失语症的患者。通过人口统计学、连续临床检查、未增强 CT 和 CT 血管造影对患者进行特征描述。失语症严重程度通过基线、出院和 6 个月时进行的 NIHSS 检查进行评估。评估人口统计学、临床和影像学因素对预后的影响。
30%的患者（n=204）存在失语症。在出院时存活的 166 例失语症患者中（中位数为 5 天），57%的患者失语症改善，38%的患者失语症缓解。在 102 例在 6 个月时进行评估的失语症患者中，86%的患者失语症改善，74%的患者完全缓解。在初始 NIHSS<5 的“轻度”中风的失语症患者中，90%的患者在 6 个月时缓解。与更好的结果显著相关的因素包括临床和影像学上较小的中风和较低的发病前残疾。
在超急性期出现的完全缓解失语症的预后良好。表明缺血程度较小的影像学和临床标志物与更大的恢复相关。鉴于轻度中风后语言恢复的良好预后，此类情况下溶栓的净效益尚不确定。
