Language improvement one week after thrombolysis in acute stroke.

Area of Science:

• Neurology
• Neuroscience
• Stroke Medicine

Background:

• Aphasia recovery post-stroke is difficult to predict.
• Timely and accurate assessment of linguistic function is crucial for guiding treatment.
• Current evaluation methods face time constraints and may not fully capture recovery.

Purpose of the Study:

• To identify predictors of aphasia recovery one week after thrombolysis.
• To determine which National Institute of Health and Stroke Scale (NIHSS) items best reflect linguistic performance.

Main Methods:

• Prospective registry data from patients with left MCA stroke treated with thrombolysis.
• Composite Verbal Score (CVS) using NIHSS Language, Questions, and Commands scores for Day 7 recovery.
• Correlation of CVS with standardized aphasia testing; lesion size assessed by ASPECTS; vascular patency by ultrasound.

Main Results:

• 72% of 228 patients showed language improvement, with 31% achieving complete recovery.
• Alberta Stroke Program Early CT score (ASPECTS) and baseline aphasia severity predicted total recovery.
• CVS correlated better with standardized aphasia measures than the NIHSS Language item alone.

Conclusions:

• Lesion size and initial aphasia severity are primary predictors of one-week post-thrombolysis aphasia recovery.
• A composite NIHSS verbal score offers a more comprehensive assessment of global linguistic performance than the NIHSS Language item alone.