Aphasia in patients with subcortical ischemic stroke

Abstract

   Objectives: To investigate the characteristics of aphasia in patients with subcortical infarction and evaluate the relationship between clinical language impairment and lesion location.

   Methods: This prospective descriptive study was conducted on patients with subcortical infarction admitted to the Cerebrovascular Disease Department, 115 People’s Hospital, from November 2017 to May 2018. Inclusion criteria consisted of first-ever ischemic stroke, symptom onset within seven days before enrollment, subcortical lesions confirmed by CT/MRI, and the ability to undergo standardized language assessment. Aphasia was evaluated using the Western Aphasia Battery (WAB), and lesion locations were analyzed based on neuroimaging. Data were processed using SPSS 16.0, with descriptive statistics and Chi-square or t- tests applied where appropriate (significance level: p < 0.05).

   Results: Among 263 patients with subcortical infarction, 68 (25.9%) exhibited aphasia. The ratio of aphasia showed no significant difference between males (51.5%) and females (48.5%) (p = 0.86). The mean age of aphasic patients was 61.57 ± 12.81 years, with females being significantly older than males (p = 0.001).

   All aphasic patients had dominant hemisphere involvement (100%), with a statistically significant difference compared to the non-aphasic group (p = 0.001). The most commonly affected subcortical structures associated with aphasia were the putamen, internal capsule, and caudate nucleus. Broca’s aphasia was the most frequent subtype (22.1%), followed by Wernicke’s aphasia (16.2%) and global aphasia (1.5%). Clinically, 66.2% of aphasic patients had facial palsy, and 94.1% were right-handed; however, no statistically significant difference was found between aphasic and non-aphasic groups (p > 0.05). Lesions in the putamen-anterior limb of the internal capsule were significantly associated with Broca’s aphasia, whereas thalamic lesions were more frequently linked to global aphasia. These findings suggest a strong correlation between language impairment in subcortical infarction and lesions in the dominant hemisphere, particularly within the basal ganglia and internal capsule.

   Conclusions: Aphasia was observed in 25.9% of patients with subcortical infarction, predominantly involving the dominant hemisphere, particularly the putamen, internal capsule, and caudate nucleus. Broca’s aphasia was the most common subtype, followed by global and Wernicke’s aphasia. Lesions in the putamen-anterior limb of the internal capsule were associated with Broca’s aphasia, while thalamic infarcts correlated with global aphasia. These findings enhance the understanding of the role of subcortical structures in language processing, aiding in the diagnosis and management of post-stroke aphasia

DOI: 10.59715/pntjmp.4.3.20