Brain, Vol. 125, No. 5, 1094-1104,
May 2002
© 2002 Guarantors of Brain
Subcortical aphasia and neglect in acute stroke: the role of cortical hypoperfusion
1 Department of Neurology and 2 Department of Radiology, Johns Hopkins University School of Medicine, 3 Johns Hopkins University Department of Cognitive Science and 4 The National Institute on Aging, Baltimore, MD 21287, USA
Correspondence to: A. Hillis, Department of Neurology, Johns Hopkins Hospital, Meyer 5-185, 600 N. Wolfe Street, Baltimore, MD 21287, USA E-mail: argye{at}JHMI.edu
We have hypothesized that most cases of aphasia or hemispatial neglect due to acute, subcortical infarct can be accounted for by concurrent cortical hypoperfusion. To test this hypothesis, we demonstrate: (i) that pure subcortical infarctions are associated with cortical hypoperfusion in subjects with aphasia/neglect; (ii) that reversal of cortical hypoperfusion is associated with resolution of the aphasia; and (iii) that aphasia/neglect strongly predicts cortical ischaemia and/or hypoperfusion. We prospectively evaluated a consecutive series of 115 patients who presented within 24 h of onset or progression of stroke symptoms, with MRI sequences including diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI), and detailed testing for aphasia or hemispatial neglect. The association between aphasia or neglect and cortical infarct (or dense ischaemia) on DWI and cortical hypoperfusion indicated by PWI, was evaluated with chi-squared analyses. Fisher exact tests were used for analyses with small samples. Cases of DWI lesion restricted to subcortical white matter and/or grey matter structures (n = 44) were examined for the presence of aphasia or neglect, and for the presence of cortical hypoperfusion. In addition, subjects who received intervention to restore perfusion were evaluated with DWI, PWI, and cognitive tests before and after intervention. Finally, the positive predictive value of the cognitive deficits for identifying cortical abnormalities on DWI and PWI were calculated from all patients. Of the subjects with only subcortical lesions on DWI in this study (n = 44), all those who had aphasia or neglect showed concurrent cortical hypoperfusion. Among the patients who received intervention that successfully restored cortical perfusion, 100% (six out of six) showed immediate resolution of aphasia. In the 115 patients, aphasia and neglect were much more strongly associated with cortical hypoperfusion (
2 = 57.3 for aphasia; 2 = 28.7 for neglect; d.f. = 1; P < 0.000001 for each), than with cortical infarct/ischaemia on DWI (2 = 8.5 for aphasia; 2 = 9.7 for neglect; d.f. = 1; P < 0.005 for each). Aphasia showed a much higher positive predictive value for cortical abnormality on PWI (95%) than on DWI (62%), as did neglect (100% positive predictive value for PWI versus 74% for DWI). From these data we conclude that aphasia and neglect due to acute subcortical stroke can be largely explained by cortical hypoperfusion.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  V. Singh-Curry, R. E Roberts, and M. Husain Diffusion tensor imaging: implications for brain disease J. Neurol. Neurosurg. Psychiatry, May 1, 2008; 79(5): 490 - 491. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Bartolomeo, M. Thiebaut de Schotten, and F. Doricchi Left Unilateral Neglect as a Disconnection Syndrome Cereb Cortex, November 1, 2007; 17(11): 2479 - 2490. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Hillis Aphasia: Progress in the last quarter of a century Neurology, July 10, 2007; 69(2): 200 - 213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Sapir, J. B. Kaplan, B. J. He, and M. Corbetta Anatomical Correlates of Directional Hypokinesia in Patients with Hemispatial Neglect J. Neurosci., April 11, 2007; 27(15): 4045 - 4051. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Y. Choi, K. H. Lee, D. L. Na, H. S. Byun, S. J. Lee, H. Kim, M. Kwon, K.-H. Lee, and B.-T. Kim Subcortical Aphasia After Striatocapsular Infarction: Quantitative Analysis of Brain Perfusion SPECT Using Statistical Parametric Mapping and a Statistical Probabilistic Anatomic Map J. Nucl. Med., February 1, 2007; 48(2): 194 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Hillis, S. Chang, J. Heidler-Gary, M. Newhart, J. T. Kleinman, C. Davis, P. B. Barker, E. Aldrich, and L. Ken Neural Correlates of Modality-specific Spatial Extinction. J. Cogn. Neurosci., November 1, 2006; 18(11): 1889 - 1898. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Saur, R. Buchert, R. Knab, C. Weiller, and J. Rother Iomazenil-Single-Photon Emission Computed Tomography Reveals Selective Neuronal Loss in Magnetic Resonance-Defined Mismatch Areas Stroke, November 1, 2006; 37(11): 2713 - 2719. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Hillis, J. T. Kleinman, M. Newhart, J. Heidler-Gary, R. Gottesman, P. B. Barker, E. Aldrich, R. Llinas, R. Wityk, and P. Chaudhry Restoring Cerebral Blood Flow Reveals Neural Regions Critical for Naming J. Neurosci., August 2, 2006; 26(31): 8069 - 8073. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Hogan, F. Vargha-Khadem, D. E. Saunders, F. J. Kirkham, and T. Baldeweg Impact of frontal white matter lesions on performance monitoring: ERP evidence for cortical disconnection Brain, August 1, 2006; 129(8): 2177 - 2188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Saur, R. Lange, A. Baumgaertner, V. Schraknepper, K. Willmes, M. Rijntjes, and C. Weiller Dynamics of language reorganization after stroke Brain, June 1, 2006; 129(6): 1371 - 1384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-O. Karnath, R. Zopf, L. Johannsen, M. F. Berger, T. Nagele, and U. Klose Normalized perfusion MRI to identify common areas of dysfunction: patients with basal ganglia neglect Brain, October 1, 2005; 128(10): 2462 - 2469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. de Boissezon, J.-F. Demonet, M. Puel, N. Marie, G. Raboyeau, J.-F. Albucher, F. Chollet, and D. Cardebat Subcortical Aphasia: A Longitudinal PET Study Stroke, July 1, 2005; 36(7): 1467 - 1473. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Hillis, M. Newhart, J. Heidler, P. B. Barker, E. H. Herskovits, and M. Degaonkar Anatomy of Spatial Attention: Insights from Perfusion Imaging and Hemispatial Neglect in Acute Stroke J. Neurosci., March 23, 2005; 25(12): 3161 - 3167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Farne, L J Buxbaum, M Ferraro, F Frassinetti, J Whyte, T Veramonti, V Angeli, H B Coslett, and E Ladavas Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients J. Neurol. Neurosurg. Psychiatry, October 1, 2004; 75(10): 1401 - 1410. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-O. Karnath, M. Fruhmann Berger, W. Kuker, and C. Rorden The Anatomy of Spatial Neglect based on Voxelwise Statistical Analysis: A Study of 140 Patients Cereb Cortex, October 1, 2004; 14(10): 1164 - 1172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Ringman, J. L. Saver, R. F. Woolson, W. R. Clarke, and H. P. Adams Frequency, risk factors, anatomy, and course of unilateral neglect in an acute stroke cohort Neurology, August 10, 2004; 63(3): 468 - 474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Hillis, M. Work, P. B. Barker, M. A. Jacobs, E. L. Breese, and K. Maurer Re-examining the brain regions crucial for orchestrating speech articulation Brain, July 1, 2004; 127(7): 1479 - 1487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Bowler Vascular Cognitive Impairment Stroke, February 1, 2004; 35(2): 386 - 388. [Full Text] [PDF]
|
|
|
|
|
|
A Parton, P Malhotra, and M Husain Hemispatial neglect J. Neurol. Neurosurg. Psychiatry, January 1, 2004; 75(1): 13 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Hillis, R. J. Wityk, P. B. Barker, J. A. Ulatowski, and M. A. Jacobs Change in Perfusion in Acute Nondominant Hemisphere Stroke May Be Better Estimated by Tests of Hemispatial Neglect Than by the National Institutes of Health Stroke Scale Stroke, October 1, 2003; 34(10): 2392 - 2396. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Merino and K. M. Heilman Editorial Comment--Measurement of Cognitive Deficits in Acute Stroke Stroke, October 1, 2003; 34(10): 2396 - 2398. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Mort, P. Malhotra, S. K. Mannan, C. Rorden, A. Pambakian, C. Kennard, and M. Husain The anatomy of visual neglect Brain, September 1, 2003; 126(9): 1986 - 1997. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J V Guadagno, C Calautti, and J-C Baron Progress in imaging stroke: emerging clinical applications Br. Med. Bull., March 1, 2003; 65(1): 145 - 157. [Abstract] [Full Text] [PDF]
|
|