title: The prognosis for aphasia in stroke.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. mmaas@partners.org
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Maas
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
authors.forename: Hakan
authors.initials: H
authors.lastname: Ay
authors.forename: Aneesh B
authors.initials: AB
authors.lastname: Singhal
authors.forename: David M
authors.initials: DM
authors.lastname: Greer
authors.forename: Wade S
authors.initials: WS
authors.lastname: Smith
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Harris
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Koroshetz
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
mesh_terms: D000208:Acute Disease; D001037:Aphasia / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome