title: Aphasia in border-zone infarcts has a specific initial pattern and good long-term prognosis.
abstract: BACKGROUND
  While border-zone infarcts (BZI) account for about 10% of strokes, studies on related aphasia are infrequent. The aim of this work was to redefine specifically their early clinical pattern and evolution.
  
  
  METHODS
  We prospectively studied consecutive patients referred to our stroke unit within a 2-year period. Cases of aphasia in right-handed patients associated with a MRI confirmed left-sided hemispheric BZI were included. These patients had a standardized language examination in the first 48 h, at discharge from stroke unit and between 6 and 18 months later.
  
  
  RESULTS
  Eight patients were included. Three had anterior (MCA/ACA), two posterior (MCA/PCA), two both anterior and posterior, and one bilateral BZI. All our patients initially presented transcortical mixed aphasia, characterized by comprehension and naming difficulties associated with preserved repetition. In all patients, aphasia rapidly improved. It fully recovered within a few days in three patients. Initial improvement was marked, although incomplete in the five remaining patients: their aphasias specifically evolved according to the stroke location toward transcortical motor aphasia for the three patients with anterior BZI and transcortical sensory aphasia for the two patients with posterior BZI. All patients made a full language recovery within 18 months after stroke.
  
  
  CONCLUSIONS
  We report a specific aphasic pattern associated with hemispheric BZI, including an excellent long-term outcome. These findings appear relevant to (i) clinically suspect BZI and (ii) plan rehabilitation and inform the patient and his family of likelihood of full language recovery.
authors.affiliation: Service de neurologie, CHU Bicêtre, AP-HP, Le Kremlin Bicêtre, France. constance.flamand-roze@bct.aphp.fr
authors.forename: C
authors.initials: C
authors.lastname: Flamand-Roze
authors.forename: C
authors.initials: C
authors.lastname: Cauquil-Michon
authors.forename: E
authors.initials: E
authors.lastname: Roze
authors.forename: R
authors.initials: R
authors.lastname: Souillard-Scemama
authors.forename: L
authors.initials: L
authors.lastname: Maintigneux
authors.forename: D
authors.initials: D
authors.lastname: Ducreux
authors.forename: D
authors.initials: D
authors.lastname: Adams
authors.forename: C
authors.initials: C
authors.lastname: Denier
mesh_terms: D000368:Aged; D001039:Aphasia, Broca / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D001041:Aphasia, Wernicke / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D002544:Cerebral Infarction / Q000145:classification / Q000150:complications* / Q000473:pathology; D032882:Comprehension; D003680:Deglutition Disorders / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function