Subcortical aphasia and neglect in acute stroke

The role of cortical hypoperfusion

A. E. Hillis, R. J. Wityk, P. B. Barker, N. J. Beauchamp, P. Gailloud, K. Murphy, O. Cooper, E. Metter

Research output: Contribution to journalArticle

210 Citations (Scopus)

Abstract

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 (Ξ2 = 57.3 for aphasia; Ξ2 = 28.7 for neglect; d.f. = 1; P < 0.000001 for each), than with cortical infarct/ischaemia on DWI (Ξ2 = 8.5 for aphasia; Ξ2 = 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.

Original languageEnglish (US)
Pages (from-to)1094-1104
Number of pages11
JournalBrain
Volume125
Issue number5
DOIs
StatePublished - Jan 1 2002

Fingerprint

Aphasia
Stroke
Perfusion Imaging
Perceptual Disorders
Ischemia
Perfusion
Cerebral Infarction

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Hillis, A. E., Wityk, R. J., Barker, P. B., Beauchamp, N. J., Gailloud, P., Murphy, K., ... Metter, E. (2002). Subcortical aphasia and neglect in acute stroke: The role of cortical hypoperfusion. Brain, 125(5), 1094-1104. https://doi.org/10.1093/brain/awf113

Subcortical aphasia and neglect in acute stroke : The role of cortical hypoperfusion. / Hillis, A. E.; Wityk, R. J.; Barker, P. B.; Beauchamp, N. J.; Gailloud, P.; Murphy, K.; Cooper, O.; Metter, E.

In: Brain, Vol. 125, No. 5, 01.01.2002, p. 1094-1104.

Research output: Contribution to journalArticle

Hillis, AE, Wityk, RJ, Barker, PB, Beauchamp, NJ, Gailloud, P, Murphy, K, Cooper, O & Metter, E 2002, 'Subcortical aphasia and neglect in acute stroke: The role of cortical hypoperfusion', Brain, vol. 125, no. 5, pp. 1094-1104. https://doi.org/10.1093/brain/awf113
Hillis AE, Wityk RJ, Barker PB, Beauchamp NJ, Gailloud P, Murphy K et al. Subcortical aphasia and neglect in acute stroke: The role of cortical hypoperfusion. Brain. 2002 Jan 1;125(5):1094-1104. https://doi.org/10.1093/brain/awf113
Hillis, A. E. ; Wityk, R. J. ; Barker, P. B. ; Beauchamp, N. J. ; Gailloud, P. ; Murphy, K. ; Cooper, O. ; Metter, E. / Subcortical aphasia and neglect in acute stroke : The role of cortical hypoperfusion. In: Brain. 2002 ; Vol. 125, No. 5. pp. 1094-1104.
@article{7eaae3cf8d4b43088675ec39589e030f,
title = "Subcortical aphasia and neglect in acute stroke: The role of cortical hypoperfusion",
abstract = "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 (Ξ2 = 57.3 for aphasia; Ξ2 = 28.7 for neglect; d.f. = 1; P < 0.000001 for each), than with cortical infarct/ischaemia on DWI (Ξ2 = 8.5 for aphasia; Ξ2 = 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.",
author = "Hillis, {A. E.} and Wityk, {R. J.} and Barker, {P. B.} and Beauchamp, {N. J.} and P. Gailloud and K. Murphy and O. Cooper and E. Metter",
year = "2002",
month = "1",
day = "1",
doi = "10.1093/brain/awf113",
language = "English (US)",
volume = "125",
pages = "1094--1104",
journal = "Brain",
issn = "0006-8950",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Subcortical aphasia and neglect in acute stroke

T2 - The role of cortical hypoperfusion

AU - Hillis, A. E.

AU - Wityk, R. J.

AU - Barker, P. B.

AU - Beauchamp, N. J.

AU - Gailloud, P.

AU - Murphy, K.

AU - Cooper, O.

AU - Metter, E.

PY - 2002/1/1

Y1 - 2002/1/1

N2 - 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 (Ξ2 = 57.3 for aphasia; Ξ2 = 28.7 for neglect; d.f. = 1; P < 0.000001 for each), than with cortical infarct/ischaemia on DWI (Ξ2 = 8.5 for aphasia; Ξ2 = 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.

AB - 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 (Ξ2 = 57.3 for aphasia; Ξ2 = 28.7 for neglect; d.f. = 1; P < 0.000001 for each), than with cortical infarct/ischaemia on DWI (Ξ2 = 8.5 for aphasia; Ξ2 = 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.

UR - http://www.scopus.com/inward/record.url?scp=0036238577&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036238577&partnerID=8YFLogxK

U2 - 10.1093/brain/awf113

DO - 10.1093/brain/awf113

M3 - Article

VL - 125

SP - 1094

EP - 1104

JO - Brain

JF - Brain

SN - 0006-8950

IS - 5

ER -