Transcranial doppler findings in aphasic patients with carotid artery stenosis or occlusions

Abstract

Introduction. Aphasia is present in 21-38% of acute ischaemic stroke individuals, being associated with short – and long-term morbidity and mortality, and can have a dramatic impact on person’s ability to communicate. A cerebro-vascular diagnostic examination is considered part of the standard work-up after cerebral ischaemia. However, only scarce data exist on the distribution steno-occlusive diseases in patients (pts) with aphasia. Transcranial Doppler (TCD) is a useful noninvasive method of intracranial circulation . We wanted to investigate the role of TCD in determination of abnormalities affecting intracranial, and/or extracranial parts of vessels supplying the brain in aphasics with acute ischemic stroke. Patients and methods. A total of 166 patients (pts) with the first acute ischaemic stroke and aphasia were selected between January 2007 and September 2008. Their language function was evaluated by means of the Romanian modified version (Kory Calomfirescu, 1996) of the Western Aphasia Battery – WAB (Kertesz A., 1980). They received Color Duplex Sonography (CDS) and Transcranial Color Duplex Sonography (CDS) examinations in the first 48 hours of onset. There was no history and no brain MRI findings of an earlier stroke. Results. The main characteristics of aphasics at admission were: N=166, gender F/M=63/103, years (mean +/-SD) = 61.06+/-8.79. The main aphasic syndrome at admission was Broca’s aphasia (55%). In 75.3% of cases (125 pts) the lesions were located at classical language centers. TCSS and CDS results were the following: 1) 65 pts (39.1%) with no changes in the intracranial hemodynamics; 2) 101 pts (60.9%) with the following changes: a) 25 pts (15.1%) with MCA or terminal ICA (C1) stenosis/occlusions; b) 76 pts (45.8%) with hypoperfusion of the L and/or R MCA. 34 pts of the hypoperfusion aphasics had a significant stenosis/ or occlusion of the extracranial ICA, with collateral circulation (through ACoA, PCoA or OA). Conclusions: 1. In our study, Broca’s aphasia was the most frequent aphasic syndrome in the acute stage of ischemic stroke in the territory of the MCA. 2. The damaged lesions of most aphasics were melted with classical language functional areas; but others sites damaged also could produce aphasia. 3. TCD was an important non-invasive method for the evaluation of the intracranial cerebral vascular diseases and of the intracranial hemodynamic impairment in the extracranial carotid diseases causing post-stroke aphasia.

Keywords

• aphasia
• acute ischemic stroke
• steno-occlusive diseases
• transcranial doppler