Aphasia outcome: the role of diffusion tensor tractography in patients with acute ischemic stroke

Abstract Backgrounds Recovery for poststroke aphasia has a decelerating trajectory, with the greatest improvement is within weeks and the slope of change decreasing over time. Therefore, it is essential to predict the prognosis of aphasia at an early stage as it could provide useful data in specific plans for management strategies. The aim of this work was to assess the arcuate fasciculus in stroke patients with aphasia and its impact on predicting the outcome. A prospective study was performed including 25 patients with acute ischemic stroke and aphasia and 10 healthy control subjects with no history of neurologic or psychiatric disease. All patients underwent language assessment using an Arabic version of the Comprehensive Aphasia Test (Arabic CAT), with the resultant mean T-score aphasia quotient (AQ). Early assessment of stroke and delayed assessment at three months. All patients had diffusion-weighted magnetic resonance imaging (DWI-MRI) of the brain to localize the lesion and 3D diffusion tensor imaging (DTI) of the arcuate fasciculus (AF) within 30 days of stroke. Results Patients in whom the AF could not be reconstructed had a poor score in early and late AQ and a poor prognosis compared to those in whom the AF could be reconstructed. Preservation of the left AF on DTI could mean the potential recovery of aphasia after stroke. Conclusion The prognosis of aphasia in patients whose left AF could be reconstructed was better than those whose left AF could not be reconstructed, irrespective of the AF's integrity. That is why, we can assume that evaluation of the DTI of the left AF at early stages of stroke can help in predicting outcome of aphasia.