Abstract WP226: Isolated Aphasia in the Emergency Department

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Background: Aphasia is a disabling consequence of ischemic stroke (IS), usually caused by strokes in the territory of the left middle cerebral artery. It is often seen as part of a larger syndrome with right hemiparesis and other left hemisphere signs. Isolated aphasia may be difficult to recognize given the lack of motor symptoms, potentially delaying treatment. Our study seeks to determine the prevalence of isolated aphasia, the rate at which these patients call 911, and the rate and speed of treatment with rt-PA compared with the general IS population.

Methods: Adult IS patients in 2005 and 2010 in the Greater Cincinnati/Northern KY region (pop. 1.3 million) were ascertained from all local hospitals via ICD-9 codes 430-436, using retrospective chart review. We limited analysis to acute IS cases that presented to an ED. Isolated aphasia was defined by a score >0 on item 9 of the initial rNIHSS (indicating language deficit) and scores of 0 on all other items except 1b and 1c. We compared rates of EMS use and rt-PA administration and median times to presentation and treatment for those with isolated aphasia versus not, using chi-square, Fisher’s exact test, t-test, or Wilcoxon rank-sum test.

Results: In 2005 and 2010, 3814 IS cases presented to EDs in the region; 22% were black, 56% were female, and the mean (SD) age was 70 (15) years. Of these, 120 (3.2%) presented with isolated aphasia. Characteristics of the isolated aphasia group are compared with all other IS in Table 1. Isolated aphasia patients showed a trend toward later arrival and lower rate of treatment with rt-PA.

Discussion: The trend toward later arrival in patients with isolated aphasia, though not statistically significant, suggests a need to better educate the public on recognizing this stroke syndrome. Isolated aphasia was significantly associated with atrial fibrillation and was associated with decreased small vessel and increased cardioembolic and undetermined stroke subtypes, a finding that merits further study.

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