الفهرس 
ISCHEMIC STROKEOnly 14 pages are availabe for public view
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Abstract
This is a cohort prospective study, carried out at Neuropsychiatry Department and Center of Psychiatry, Neurology and Neurosurgery, Tanta University Hospitals during a 12-month period, started from January 2017 to January 2018. The aim of this work is to predict factors influencing aphasia outcome in patients with ischemic stroke. A total of 34 cases were finally included in this study after fulfilling the inclusion and exclusion criteria, 12 patients who had receptive or global aphasia, were not suitable for fMRI. Inclusion criteria 1. Aphasia in patients with ischemic stroke. 2. Native language Arabic. 3. Age <80 years. Exclusion criteria 1. Inability to perform the language-task due to severity of aphasia. 2. Reduced general health status. 3. Hearing, visual deficits. 4. Cognitive impairment other than aphasia. 5. Any contraindication to MRI. All patients in this study were subjected to the following: 1)History taking including the personal history and associated risk factors such as: Hypertension, Diabetes Mellitus, dyslipidemia and cardiac diseases. 2)Clinical examination including general and neurological examination including NIHSS score, also aphasia assessment using ART at day one and day eight. Aphasia outcome assessment score using AHS. 3)Neuroradiology CT brain, MRI, fMRI BOLD technique using sentence reading paradigm and DTI. The study revealed the following: The total number of the studied patients was 34,52.9% were males (18 patients) and 47% were females (16 patients). The age of the studied patients ranged from28-79 years. High educational level was found in 9 of the studied patients while 17 were illiterates and low educational level. Right handed patients were 88.24% while 8.82% were left handed,2.94% were ambidextrous. Age was significantly affecting aphasia outcome as older patients ranged from 50-79 years showed the worst prognosis (severe language disability and mutism), while younger patients (29-52) years had normal language outcome. Sex difference and handedness didn’t affect aphasia outcome, while educational level was a significant variable, as 75% of those with high educational level had a normal language recovery (better outcome) in contrary to those who were illiterate or of low educational level; they constituted the majority of the category of severe language deficits and mutism. Risk factors as HTN, DM, cardiac diseases, smoking, dyslipidemia had a negative effect regarding aphasia outcome and their patients constituted the majority of severe language deficits and mutism. Global aphasia had the worst prognosis in relation to aphasia outcome, their patients constituted 2/66.67% of those with mutism and 3/42.86% of those with severe language deficits while those with expressive and receptive aphasia constituted the majority of moderate language deficits by 5/55.56% and 3/33.33% respectively. In Contrary, better outcome was found in mild language deficits as trans
cortical motor aphasia and trans cortical sensory aphasia patients who fall mainly in normal, minor and mild aphasia outcome, in addition conductive aphasia showed better outcomes despite low sample size. Lesion size was a significant variable as those with complete (large) infarction had the worst prognosis and constituted the majority of severe language disability and mutism by 5/71.43% and 2/66.67% respectively followed by partial infarction, while those with lacunar infarction had the best outcome as its 5/83% of their patients fall in the normal, minor and mild language disability. Lesion site was vital regarding aphasia severity and prognosis as poorer prognosis found in peri-sylvian lesions affecting both Broca’s and Wernicke’s area, they constituted the majority of severe language disability 4/57.14% and mutism 2/66.67%, in contrary to extra-sylvian lesions that showed normal, minor and mild language disability in majority of their patients (5/71%), while 2/29% of their patients fall in the severe language disability and mutism. Also those with either Broca’s or Wernicke’s area lesion had worse outcome than those with extra-sylvian lesions yet better than those with peri-sylvian lesions. Patients who had activity in bilateral or perilesional area in fMRI showed better language outcome, in contrary patients with contralateral activity alone showed poorer outcome. Patients who showed reconstruction of the AF using DTI had better outcome than those who didn’t. Patients who received rtPA (15 patients) had a better recovery from language disability than those who didn’t receive it (19 patients). Patients with higher scores of ART at Day 8 and NIHSS (initial stroke severity) showed bad prognosis regarding aphasia outcome while ART Day 1 wasn’t a significant tool.