Aphasia Workup: Laboratory Studies, Imaging Studies, Other Tests

Sections

Aphasia

Sections Aphasia
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
References

Workup

Laboratory Studies

The diagnosis of aphasia is based on physical examination and detailed mental state examination.

Aphasia is a sign as much as it is a clinical problem. Therefore, the laboratory tests required depend on the underlying pathophysiology.

Imaging Studies

Neuroimaging is required to localize and diagnose the cause of aphasia. CT scanning and MRI are the mainstays of neuroimaging.

CT effectively demonstrates acute bleeds and most ischemic strokes older than 48 hours; however, it may miss strokes less than 48 hours old.

MRI with diffusion-weighted imaging detects strokes as early as an hour after onset. New imaging sequences such as the T2* or gradient echo imaging are sensitive to detect hemorrhage, an early limitation of MRI technology.

Contrast enhancement may be required to demonstrate tumors by both CT and MRI.

Thin sections through the temporal lobes can demonstrate hippocampal atrophy or sclerosis, which are common in epilepsy and dementia. Coronal imaging on MRI is especially helpful in the detection of asymmetric hippocampal atrophy.

At a time when gross atrophy of the tissue is hard to detect, PET and SPECT may be helpful in detecting hypometabolism or reduced cerebral blood flow, respectively, in dementing illnesses. These techniques are also useful in localization of epileptic foci.

Functional MRI is increasingly being used in the study of normal activation of language structures in healthy subjects. In research studies, these techniques have also proven useful in elucidating patterns of recovery after neurologic injury such as a stroke with aphasia.^[27]While early research indicated that homologous areas of the right hemisphere might subserve language recovery, recent studies have shown that activation of adjacent left hemisphere cortex is associated with more complete recovery of language function.^[28]

Other Tests

EEG is important in patients with suspected seizures.

Neuropsychological testing and speech therapy evaluation are helpful for guiding therapy for aphasia.

Treatment & Management

Geschwind N. Disconnexion syndromes in animals and man. I. Brain. 1965 Jun. 88(2):237-94. [QxMD MEDLINE Link].
Conroy P, Scowcroft J. Decreasing cues for a dynamic list of noun and verb naming targets: A case-series aphasia therapy study. Neuropsychol Rehabil. 2012 Jan 16. [QxMD MEDLINE Link].
Alexander MP, Naeser MA, Palumbo C. Broca's area aphasias: aphasia after lesions including the frontal operculum. Neurology. 1990 Feb. 40(2):353-62. [QxMD MEDLINE Link].
Mohr JP, Pessin MS, Finkelstein S, Funkenstein HH, Duncan GW, Davis KR. Broca aphasia: pathologic and clinical. Neurology. 1978 Apr. 28 (4):311-24. [QxMD MEDLINE Link].
Kreisler A, Godefroy O, Delmaire C, et al. The anatomy of aphasia revisited. Neurology. 2000 Mar 14. 54(5):1117-23. [QxMD MEDLINE Link].
Naeser MA, Helm-Estabrooks N, Haas G, et al. Relationship between lesion extent in 'Wernicke's area' on computed tomographic scan and predicting recovery of comprehension in Wernicke's aphasia. Arch Neurol. 1987 Jan. 44(1):73-82. [QxMD MEDLINE Link].
Hillis AE, Gold L, Kannan V, et al. Site of the ischemic penumbra as a predictor of potential for recovery of functions. Neurology. 2008 Jul 15. 71(3):184-9. [QxMD MEDLINE Link].
Binder JR. Current Controversies on Wernicke's Area and its Role in Language. Curr Neurol Neurosci Rep. 2017 Aug. 17 (8):58. [QxMD MEDLINE Link].
Binder JR. The Wernicke area: Modern evidence and a reinterpretation. Neurology. 2015 Dec 15. 85 (24):2170-5. [QxMD MEDLINE Link].
Bonilha L, Hillis AE, Hickok G, den Ouden DB, Rorden C, Fridriksson J. Temporal lobe networks supporting the comprehension of spoken words. Brain. 2017 Sep 1. 140 (9):2370-2380. [QxMD MEDLINE Link].
Caramazza A. Minding the facts: a comment on Thompson-Schill et al.'s "A neural basis for category and modality specificity of semantic knowledge". Neuropsychologia. 2000. 38(7):944-9. [QxMD MEDLINE Link].
Naeser MA, Alexander MP, Helm-Estabrooks N, Levine HL, Laughlin SA, Geschwind N. Aphasia with predominantly subcortical lesion sites: description of three capsular/putaminal aphasia syndromes. Arch Neurol. 1982 Jan. 39 (1):2-14. [QxMD MEDLINE Link].
Fromm D, Holland AL, Swindell CS, Reinmuth OM. Various consequences of subcortical stroke. Prospective study of 16 consecutive cases. Arch Neurol. 1985 Oct. 42 (10):943-50. [QxMD MEDLINE Link].
Alexander MP, Naeser MA, Palumbo CL. Correlations of subcortical CT lesion sites and aphasia profiles. Brain. 1987 Aug. 110 ( Pt 4):961-91. [QxMD MEDLINE Link].
Weiller C, Willmes K, Reiche W, Thron A, Isensee C, Buell U, et al. The case of aphasia or neglect after striatocapsular infarction. Brain. 1993 Dec. 116 ( Pt 6):1509-25. [QxMD MEDLINE Link].
Kirshner HS, Kistler KH. Aphasia after right thalamic hemorrhage. Arch Neurol. 1982 Oct. 39 (10):667-9. [QxMD MEDLINE Link].
Crosson B. Subcortical Functions in Language and Memory. New York, NY: Guilford; 1992.
Dejerine J. Contribution a l'etude anatomo-pathologique et clinique des differentes varieties de cecite verbales. Memoires Societe Biologie. 1892. 4:61-90.
Damasio AR, Damasio H. The anatomic basis of pure alexia. Neurology. 1983 Dec. 33(12):1573-83. [QxMD MEDLINE Link].
Benton AL. The fiction of the Gerstmann syndrome. J Neurol Neurosurg Psychiatry. 1961. 24:961-991.
Benton AL. Gerstmann's syndrome. Arch Neurol. 1992 May. 49(5):445-7. [QxMD MEDLINE Link].
Mesulam MM. Primary progressive aphasia. Ann Neurol. 2001 Apr. 49 (4):425-32. [QxMD MEDLINE Link].
Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011 Mar 15. 76 (11):1006-14. [QxMD MEDLINE Link].
Kirshner HS. Frontotemporal dementia and primary progressive aphasia, a review. Neuropsychiatr Dis Treat. 2014. 10:1045-55. [QxMD MEDLINE Link].
Heiss WD, Kessler J, Thiel A, Ghaemi M, Karbe H. Differential capacity of left and right hemispheric areas for compensation of poststroke aphasia. Ann Neurol. 1999 Apr. 45 (4):430-8. [QxMD MEDLINE Link].
Hupfeld KE, Zöllner HJ, Oeltzschner G, Hyatt HW, Herrmann O, Gallegos J, et al. Brain total creatine differs between primary progressive aphasia (PPA) subtypes and correlates with disease severity. Neurobiol Aging. 2023 Feb. 122:65-75. [QxMD MEDLINE Link].
Meinzer M, Beeson PM, Cappa S, Crinion J, Kiran S, Saur D, et al. Neuroimaging in aphasia treatment research: consensus and practical guidelines for data analysis. Neuroimage. 2013 Jun. 73:215-24. [QxMD MEDLINE Link].
Appell J, Kertesz A, Fisman M. A study of language functioning in Alzheimer patients. Brain Lang. 1982 Sep. 17 (1):73-91. [QxMD MEDLINE Link].
Fridriksson J, Rorden C, Elm J, Sen S, George MS, Bonilha L. Transcranial Direct Current Stimulation vs Sham Stimulation to Treat Aphasia After Stroke: A Randomized Clinical Trial. JAMA Neurol. 2018 Dec 1. 75 (12):1470-1476. [QxMD MEDLINE Link].
Saxena S, Hillis AE. An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia. Expert Rev Neurother. 2017 Nov. 17 (11):1091-1107. [QxMD MEDLINE Link].
Berthier ML, Green C, Lara JP, Higueras C, Barbancho MA, Dávila G, et al. Memantine and constraint-induced aphasia therapy in chronic poststroke aphasia. Ann Neurol. 2009 May. 65 (5):577-85. [QxMD MEDLINE Link].