Background: Previous studies have suggested that patients with a transient ischemic attack (TIA) or minor ischemic stroke and isolated aphasia should be carefully screened for a potential cardiac source of embolism. Most of these publications, however, were case reports or small-series. The purpose of this study was to assess the relationship between isolated aphasia and atrial fibrillation (AF) as the cause of presumed cardioembolic TIA or stroke within the setting of 2 large multicenter trials. Methods: The frequency of isolated aphasia was compared between patients with a TIA or minor ischemic stroke either with AF [European Atrial Fibrillation Trial (EAFT), n = 1,001] or without AF [Dutch TIA Trial (DTT), n = 3,150]. We analyzed data with univariable and multivariable logistic regression. Isolated aphasia was defined as aphasia without dysarthria, visual-field defects or motor or sensory deficits of the arm, leg or face. Because dysarthria can be difficult to detect in aphasic patients, a second analysis was done without excluding dysarthric patients. In a third analysis, we excluded patients with a symptomatic lacunar infarct from the DTT, as these patients were overrepresented due to the exclusion of patients with AF. Subgroup analysis was performed for patients presenting with TIA and minor stroke. Results: Of 4,151 patients, 210 (5.1%) had isolated aphasia, 109 from the EAFT and 101 from the DTT, crude odds ratio (OR) 3.69, 95% confidence interval (CI) 2.79-4.89. Patients with isolated aphasia were older (mean age 70.3 vs. 66.8 years, p < 0.01), more often female (OR 1.87, 95% CI 1.41-2.46), and more often had diabetes (OR 1.73, 95% CI 1.16-2.59) and hypercholesterolemia (OR 1.83, 95% CI 1.11-3.03) than those without aphasia. After simultaneous adjustment for age, sex, diabetes and hypercholesterolemia, patients with isolated aphasia still had AF more often than patients without isolated aphasia (adjusted OR 2.94, 95% CI 2.16-4.01). Both after inclusion of patients with dysarthria in the group of patients with isolated aphasia and after exclusion of patients with a symptomatic lacunar infarct, essentially the results remained the same. Patients presenting with isolated aphasia due to a TIA tended to have AF more often than patients with a minor ischemic stroke. Conclusions: Isolated aphasia is an independent sign of AF in patients with a TIA or minor ischemic stroke. Careful cardiac screening seems warranted in patients with isolated aphasia, as secondary prevention is different in patients with a cardiac source of embolism.

Keywords:
Atrial fibrillation, Isolated aphasia, Cardioembolic stroke
1.
Van Horn G, Hawes A: Global aphasia without hemiparesis: a sign of embolic encephalopathy. Neurology 1982;32:403-406.
2.
Hanlon RE, Lux WE, Dromerick AW: Global aphasia without hemiparesis: language profiles and lesion distribution. J Neurol Neurosurg Psychiatry 1999;66:365-369.
3.
Tranel D, Biller J, Damasio H, Adams HP Jr, Cornell SH: Global aphasia without hemiparesis. Arch Neurol 1987;44:304-308.
4.
van Gijn J, Algra A: Anticoagulation in ischemic stroke: opportunities in arterial disease. Cerebrovasc Dis 2005;20(suppl 2):101-108.
5.
European Atrial Fibrillation Trial Study Group: Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-1262.
6.
The Dutch TIA Trial Study Group: A comparison of two doses of aspirin (30 vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N Engl J Med 1991;325:1261-1266.
7.
The Dutch TIA Trial Study Group: Trial of secondary prevention with atenolol after transient ischemic attack or nondisabling ischemic stroke. Stroke 1993;24:543-548.
8.
Boiten J, Lodder J: Lacunar infarcts. Pathogenesis and validity of the clinical syndromes. Stroke 1991;22:1374-1378.
9.
van Latum J, Koudstaal PJ, Kappelle LJ, van KF, Algra A, van Gijn J: Comparison of CT in patients with cerebral ischaemia with or without non-rheumatic atrial fibrillation. European Atrial Fibrillation Trial and Dutch TIA Trial Study Groups. J Neurol Neurosurg Psychiatry 1995;59:132-137.
10.
Croquelois A, Bogousslavsky J: Stroke aphasia: 1,500 consecutive cases. Cerebrovasc Dis 2011;31:392-399.
11.
Lamassa M, Di CA, Pracucci G, Basile AM, Trefoloni G, Vanni P, Spolveri S, Baruffi MC, Landini G, Ghetti A, Wolfe CD, Inzitari D: Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project). Stroke 2001;32:392-398.
12.
Foerch C, Misselwitz B, Sitzer M, Berger K, Steinmetz H, Neumann-Haefelin T, Arbeitsgruppe Schlaganfall Hessen: Difference in recognition of right and left hemispheric stroke. Lancet 2005;366:392-393.
13.
Bogousslavsky J: Global aphasia without other lateralizing signs. Arch Neurol 1988;45:143.
14.
Deleval J, Leonard A, Mavroudakis N, Rodesch G: Global aphasia without hemiparesis following prerolandic infarction. Neurology 1989;39:1532-1535.
15.
Legatt AD, Rubin MJ, Kaplan LR, Healton EB, Brust JC: Global aphasia without hemiparesis: multiple etiologies. Neurology 1987;37:201-205.
16.
Bang OY, Heo KG, Kwak Y, Lee PH, Joo IS, Huh K: Global aphasia without hemiparesis: lesion analysis and its mechanism in 11 Korean patients. J Neurol Sci 2004;217:101-106.
17.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE, III: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.