Ischemia in Broca Area Is Associated With Broca Aphasia More Reliably in Acute Than in Chronic Stroke

DOI Web Site 被引用文献2件
  • Elisa Ochfeld
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.
  • Melissa Newhart
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.
  • John Molitoris
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.
  • Richard Leigh
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.
  • Lauren Cloutman
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.
  • Cameron Davis
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.
  • Jennifer Crinion
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.
  • Argye E. Hillis
    From Departments of Neurology (E.O., M.N., J.M., R.L., L.C., C.D., J.C., A.E.H.) and Physical Medicine and Rehabilitation (A.E.H.), Johns Hopkins Cognitive Science (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, Md; Institute of Cognitive Neuroscience (J.C.), University College London, London, UK.

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<jats:p> <jats:bold> <jats:italic>Background and Purpose—</jats:italic> </jats:bold> We aimed to determine if ischemia involving Broca area predicts Broca aphasia more reliably in acute or chronic stroke. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods—</jats:italic> </jats:bold> We included consecutive right-hand-dominant patients with left hemisphere ischemic stroke (<48 hours from onset for acute stroke or >6 months after stroke for chronic stroke). MRI scans were analyzed for ischemic lesions or hypoperfusion in Broca area (Brodmann areas 44 and 45). Patients were scored on the Western Aphasia Battery to classify aphasia syndromes; χ <jats:sup>2</jats:sup> tests were used to identify significant associations. </jats:p> <jats:p> <jats:bold> <jats:italic>Results—</jats:italic> </jats:bold> The presence of infarct involving any part of Broca area and the presence of Broca or global aphasia was much stronger in acute (χ <jats:sup>2</jats:sup> =38.1; <jats:italic>df</jats:italic> 1; <jats:italic>P</jats:italic> <0.0001) than in chronic stroke (χ <jats:sup>2</jats:sup> =0.54; <jats:italic>df</jats:italic> 1; <jats:italic>P</jats:italic> =0.46; not significant). The association between infarct or hypoperfusion covering all of Broca area and the presence of Broca or global aphasia was much stronger in acute (χ <jats:sup>2</jats:sup> =35.8; <jats:italic>df</jats:italic> 1; <jats:italic>P</jats:italic> <0.0001) than in chronic stroke (χ <jats:sup>2</jats:sup> =1.2; <jats:italic>df</jats:italic> 1; <jats:italic>p=</jats:italic> 0.27; not significant). In a subset of 20 patients studied longitudinally, the associations were significant only acutely, not chronically (χ <jats:sup>2</jats:sup> =20; <jats:italic>df</jats:italic> 1; <jats:italic>P</jats:italic> <0.0001 vs. χ <jats:sup>2</jats:sup> =0; <jats:italic>df</jats:italic> 1; <jats:italic>p=</jats:italic> 1; not significant for ischemia involving part of Broca area, and χ <jats:sup>2</jats:sup> =16.4; <jats:italic>df</jats:italic> 1; <jats:italic>P</jats:italic> <0.0001 vs χ <jats:sup>2</jats:sup> =3.2; <jats:italic>df</jats:italic> 1; <jats:italic>p=</jats:italic> 0.08; not significant for ischemia covering all of Broca area). </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Broca aphasia is more reliably associated with infarct/ hypoperfusion of Broca area in acute stroke. Many chronic stroke patients with damage to part or all of Broca area had neither Broca nor global aphasia. Broca or global aphasia was sometimes present initially in these patients but resolved by 6 months. Our results indicate that the acute aphasia syndrome may allow the clinician to predict the compromised vascular territory, even when structural imaging shows only a small (or no) infarct. </jats:p>

収録刊行物

  • Stroke

    Stroke 41 (2), 325-330, 2010-02

    Ovid Technologies (Wolters Kluwer Health)

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