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Dissociation of severity of stroke and aphasia recovery early after intravenous recombinant tissue plasminogen activator thrombolysis

Kremer, Christine
Kappelin, Johan
Published in Journal of clinical neuroscience. 2014, vol. 21, no. 10, p. 1828-1830
Abstract Clinical observation suggested to us that aphasia recovers relatively better than other deficits early after intravenous recombinant tissue plasminogen activator (IV-rtPA) treatment in stroke patients with minor deficits, while the reverse seemed the case in those with severe deficits. Retrospective analysis of acute ischemic stroke patients with aphasia admitted within 3 hours from symptom onset and treated with IV-rtPA was carried out. Stroke severity, aphasia and global neurological impairment were assessed at admission and 24 hours after thrombolysis. Improvement of aphasia (gain of ⩾ 1 point on the National Institutes of Health Stroke Scale [NIHSS] aphasia score) and global neurological improvement (gain of ⩾ 4 points on the NIHSS) were compared in minor strokes (NIHSS ⩽ 7), moderate strokes (NIHSS 8-15), and major strokes (NIH ⩾ 16). Sixty-nine of 243 stroke patients suffered from aphasia. Improvement of aphasia occurred in 7/16 minor strokes, 11/25 moderate strokes, and 7/28 severe strokes. Improvement of ⩾ 4 points on the NIHSS occurred in 3/16 minor strokes, 17/25 moderate strokes and 15/28 severe strokes. There is a significant (X(2)=4.073, p<0.05) dissociation of recovery of aphasia and that of other neurological deficits between minor versus severe strokes. This confirms the clinically suspected dissociation between a good early recovery from aphasia in minor strokes relative to recovery of other neurological deficits, as opposed to a better recovery from other neurological deficits than from aphasia in patients with severe strokes.
Keywords Administration, IntravenousAphasia/drug therapy/etiologyBrain Ischemia/complications/drug therapyFemaleFibrinolytic Agents/therapeutic useFollow-Up StudiesHumansMaleMiddle AgedRecombinant Proteins/therapeutic useRecovery of Function/drug effectsSeverity of Illness IndexStroke/complications/drug therapyThrombolytic TherapyTissue Plasminogen Activator/therapeutic use
PMID: 24852905
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Research group Laboratoire de neuroimagerie clinique d'ultrasons ultrarapides (972)
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KREMER, Christine, KAPPELIN, Johan, PERREN, Fabienne. Dissociation of severity of stroke and aphasia recovery early after intravenous recombinant tissue plasminogen activator thrombolysis. In: Journal of clinical neuroscience, 2014, vol. 21, n° 10, p. 1828-1830. doi: 10.1016/j.jocn.2014.01.010 https://archive-ouverte.unige.ch/unige:90316

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Deposited on : 2016-12-14

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