title: Thrombolysis in Stroke Patients with Isolated Aphasia.
abstract: BACKGROUND
  Data about evolution of aphasia following stroke are rare and controversial especially following fibrinolysis. The aim of this study was to describe the early clinical patterns of isolated aphasia in consecutive stroke patients with or without thrombolysis.
  
  
  METHODS
  Clinical and radiological data of consecutive stroke patients were routinely entered in prospective registry. Patients were considered aphasic when NIHSS (National Institutes of Health Stroke Scale) item 9 >0. 'Isolated aphasia' was defined by aphasic patients without motor limb deficit. We created a 'composite language score' obtained by summing the NIHSS items 1b, 1c and 9, which reflects language-processing ability. Recovery of functions was evaluated as measured by global NIHSS, composite language score and language screening test (LAST) at baseline, H24 and day 7 (D7). 'Mild deficit' was defined as global NIHSS <5.
  
  
  RESULTS
  A total of 100 consecutive patients met study criteria for isolated aphasia. Twenty-five underwent thrombolysis and 75 did not. There was no difference between the 2 groups concerning demographic characteristics, involved territories and presence of arterial occlusion, initial median NIHSS, composite language and LAST scores at entrance. Evolution was significantly better in thrombolysed patient for the 3 testings: NIHSS, composite language score and LAST at D7 (respective p = 0.0002; p = 0.01 and p = 0.004). Similar results were found when we focused on the subgroups of patients with initial 'mild' deficits (p = 0.01; p = 0.0003 and p = 0.007). No symptomatic hemorrhagic transformation occurred following thrombolysis.
  
  
  CONCLUSIONS
  These data strongly suggest that thrombolysis is safe and effective in patients with 'isolated aphasia,' even if the global NIHSS score is <5.
authors.affiliation: Department of Neurology and Stroke Center, Paris-Sud University, Le Kremlin-Bicx00EA;tre, France.
authors.forename: C
authors.initials: C
authors.lastname: Denier
authors.forename: O
authors.initials: O
authors.lastname: Chassin
authors.forename: C
authors.initials: C
authors.lastname: Vandendries
authors.forename: L
authors.initials: L
authors.lastname: Bayon de la Tour
authors.forename: C
authors.initials: C
authors.lastname: Cauquil
authors.forename: M
authors.initials: M
authors.lastname: Sarov
authors.forename: D
authors.initials: D
authors.lastname: Adams
authors.forename: C
authors.initials: C
authors.lastname: Flamand-Roze
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000188:drug therapy* / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator