title: Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism.
abstract: OBJECTIVE
  A cardiac source is often implicated in strokes where the deficit includes aphasia. However, less is known about the etiology of isolated aphasia during transient ischemic attack (TIA). Our objective was to determine whether patients with isolated aphasia are likely to have a cardioembolic etiology for their TIA.
  
  
  METHODS
  We prospectively studied a cohort of TIA patients in eight tertiary-care emergency departments. Patients with isolated aphasia were identified by the treating physician at the time of emergency department presentation. Patients with dysarthria (i.e., a phonation disturbance) were not included. Potential cardiac sources for embolism were defined as atrial fibrillation on history, electrocardiogram, Holter monitor, atrial fibrillation on echocardiography, or thrombus on echocardiography.
  
  
  RESULTS
  Of the 2,360 TIA patients identified, 1,155 had neurological deficits at the time of the emergency physician assessment and were included in this analysis, and 41 had isolated aphasia as their only neurological deficit. Patients with isolated aphasia were older (73.9±10.0 v. 67.2±14.5 years; p=0.003), more likely to have a history of heart failure (9.8% v. 2.6%; p=0.027), and were twice as likely to have any cardiac source of embolism (22.0% v. 10.6%; p=0.037).
  
  
  CONCLUSIONS
  Isolated aphasia is associated with a high rate of cardioembolic sources of embolism after TIA. Emergency patients with isolated aphasia diagnosed with a TIA warrant a rapid and thorough assessment for a cardioembolic source.
authors.affiliation: *Department of Laboratory Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Wasserman
authors.affiliation: †Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
authors.affiliation: ‡Division of Neurology,Department of Medicine,The Ottawa Hospital,University of Ottawa,Ottawa,ON.
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: ‡Division of Neurology,Department of Medicine,The Ottawa Hospital,University of Ottawa,Ottawa,ON.
authors.forename: Grant
authors.initials: G
authors.lastname: Stotts
authors.affiliation: ¶Department of Emergency Medicine,Queen's University,Kingston,ON.
authors.forename: Marco L A
authors.initials: ML
authors.lastname: Sivilotti
authors.affiliation: **Department of Medicine,McMaster University,Hamilton,ON.
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.affiliation: ††Unité de Traumatologie-urgence-soins Intensifs,Center de Recherche du CHA (Hôpital de l'Enfant-Jésus),Laval University,Quebec,QC.
authors.forename: Marcel
authors.initials: M
authors.lastname: Emond
authors.affiliation: †Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Jane
authors.initials: J
authors.lastname: Sutherland
authors.affiliation: †Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.affiliation: ‡‡Population Health Research Institute,McMaster University,Hamilton,ON.
authors.forename: Mukul
authors.initials: M
authors.lastname: Sharma
mesh_terms: D000368:Aged; D001037:Aphasia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
keywords: atrial fibrillation; cardioembolism; isolated aphasia; risk; stroke; transient ischemic attack