Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di fiume, 447 - 34149, Trieste, Italy.
Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di fiume, 447 - 34149, Trieste, Italy.
Seizure. 2019 Oct;71:110-115. doi: 10.1016/j.seizure.2019.07.005. Epub 2019 Jul 4.
Isolated speech impairment is one of the most challenging clinical manifestations of stroke mimic (SM). We aimed to investigate perfusional and EEG pattern of isolated aphasia to better differentiate between vascular and epileptic etiology in emergency settings.
We retrospectively analyzed 481 cases with acute focal neurological symptoms admitted to our Stroke Unit. The patients showing isolated aphasia and confirmed ischemic infarction or SM with seizure etiology on follow-up were included for subsequent analysis of clinical, neuroimaging, and EEG data. We investigated differences in CT Perfusion maps between ROI in the anatomical area compatible with clinical presentation, contralateral ROI and EEG in order to evaluate perfusion and brain oscillatory activity abnormalities.
45 patients presented isolated aphasia as principal neurological symptom: 27 cases due to acute ischemic event, 11 due to seizure SM, while 7 were SM due to other etiologies. Out of 11 SM patients with seizure etiology, significant hyperperfusion on CTP maps (MTT AI%<-10%) and sharp EEG waves were observed in 8 patients, while in 3 patients slight hypoperfusion (MTT AI%<20%) and slow EEG rhythms were detected. 24 out of 27 ischemic stroke patients presented severe hypoperfusion with MTT AI above the stroke threshold (MTT AI > 45%). All ischemic stroke patients presented slower EEG rhythms.
The main finding of this study is the identification of different clinical and neuroimaging patterns of isolated aphasia with epileptic or ischemic etiology in emergency settings.
孤立性言语障碍是中风样发作（SM）最具挑战性的临床表现之一。我们旨在研究孤立性失语症的灌注和脑电图模式，以便在急诊环境中更好地区分血管性和癫痫性病因。
我们回顾性分析了 481 例因急性局灶性神经症状而入住我们的卒中病房的患者。对出现孤立性失语症且在随访中证实为缺血性梗死或伴有癫痫病因的 SM 患者进行进一步分析，以评估临床、神经影像学和脑电图数据。我们研究了 CT 灌注图中与临床表现解剖区域相对应的 ROI、对侧 ROI 和 EEG 之间的差异，以评估灌注和脑振荡活动异常。
45 例患者以孤立性失语为主要神经症状：27 例为急性缺血性事件，11 例为癫痫性 SM，7 例为其他病因的 SM。11 例有癫痫病因的 SM 患者中，8 例 CTP 图上明显过度灌注（MTT AI%<-10%）和尖锐脑电图波，3 例轻度低灌注（MTT AI%<20%）和缓慢脑电图节律。27 例缺血性卒中患者中有 24 例 MTT AI 高于卒中阈值（MTT AI>45%），表现出严重低灌注。所有缺血性卒中患者的脑电图节律均较慢。
本研究的主要发现是在急诊环境中确定了具有癫痫或缺血性病因的孤立性失语症的不同临床和神经影像学模式。
