Computed Tomography Perfusion Imaging: A Key Initial Test for Isolated Acute Aphasia in the Emergency Department

Computed tomography perfusion (CTP) is a widely available imaging test in the initial assessment of acute neurological symptoms. Acute isolated aphasia is a common symptom in this group of patients, in whom an etiopathogenic diagnosis can be challenging. The aim of this study was to assess the usefulness of CTP for the initial management of this syndrome, and to evaluate whether the detection of certain perfusion patterns can be valuable in the diagnostic process.

CTP scans performed in our hospital between 2019 and 2022 were retrospectively analyzed. Individuals with acute isolated aphasia who attended the emergency department within this period were included. Diagnostic, demographic, clinical, neuroimaging, electroencephalography (EEG), other complementary test, and follow-up data were collected.

Of the 1880 CTP exams performed, 175 (9.3%) patients presented with acute isolated aphasia, 50% of whom were female, with a median age of 71.5 (Interquartile range (IQR) 61-80) years. The etiology was vascular in 91 (52%) patients, epileptic in 26 (14.9%) patients, and due to other causes in 58 (33.1%) patients. Differences in perfusion patterns were detected between the different etiologies (p < 0.001), particularly in cases of epileptic origin, where hyperperfusion had a high positive predictive value for status epilepticus (83%). In this series, concrete clinical conditions such as National Institutes of Health Stroke Scale (NIHSS) score at admission and discharge, altered mental status, and fever at onset of symptoms were associated with a specific etiology.

CTP imaging is a valuable diagnostic tool for acute isolated aphasia, enabling the optimization of acute treatment in these patients, particularly in status epilepticus and stroke.