Language improvement one week after thrombolysis in acute stroke

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Aphasia is one of the most disabling neurological conditions, with a significant impact on quality of life, mood, and ability to return to work 1. It occurs in 15–40% of individuals with left hemisphere stroke and persists in 12.5–50% 3. Most data on aphasia recovery were obtained before the modern era of thrombolytic therapy. However, the treatment with recombinant tissue plasminogen activator (rTPA), particularly if early recanalization is achieved, can modify the size, pattern, and nature of infarcts following ischemic stroke 7. As a consequence, the linguistic impairments following a stroke as well as their expected prognosis could also be different. Given the current recommendation to use intravenous thrombolysis as the standard of care in acute stroke patients fulfilling the inclusion criteria, it is important to reevaluate the factors associated with aphasia recovery.
The outcome of aphasia is difficult to predict within the first days of stroke. Several reasons and time constraints preclude the use of standardized batteries of tests for language assessment before rTPA 5. The NIHSS (National Institute of Health and Stroke Scale) is the gold standard assessment tool to evaluate neurological deficits in acute stroke patients. Nonetheless, the language item of the scale has been criticized due to its inability to differentiate between aphasic symptoms, its poor evaluation of comprehension, and its failure to identify mild symptoms 11. A factor analysis of the NIHSS 13 identified two items that are loaded in the same factor as language: the request to answer some questions (item 1b) and the response to verbal commands (1c). Although not tackling language specifically, these items can be considered indirect measures of aphasia. In two recent studies 12, they were used in a compound measure to evaluate language improvement, but so far they have not been validated as such.
In this study, we aimed to assess: (i) the validity of the NIHSS composite verbal score (CVS), comparing it to quantitative measures obtained in a standardized assessment; (ii) language recovery in the first week after thrombolysis and to identify prognostic factors among clinical and imaging variables.

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