Recovery From Aphasia After Decompressive Surgery in Patients With Dominant Hemispheric Infarction
To the Editor:
The stroke patients with space occupying supratentorial lesions have poor prognosis. Despite the treatment procedures, the mortality of such patients is up to 80%, and the survivors usually have severe morbidity such as aphasia.1 In recent years, decompressive surgery was used for the treatment of space occupying supratentorial infarctions.2
Kastrau et al reported recovery from aphasia in 13 of 14 patients with large hemispheric infarctions after decompressive surgery.3 However, the study was performed by a neurolinguistic center, and the patients were first evaluated 538 days (ranges 105 to 1207 days) after the decompressive surgery, then the recovery from aphasia was determined within the following period. Same authors also reported that most of the recovery from aphasia occurs within the early period after the event. In our hospital (University of Trakya, School of Medicine), 29 patients underwent decompressive craniectomy between August 1999 and December 2003, 8 of the patients who survived had dominant hemispheric infarction, and all had recovery from aphasia within the six-month period after the event. Initial neurological examination of the 8 patients revealed global aphasia. Six months after surgery, 5 of the patients had Broca aphasia and the remaining 3 patients had slight recovery from global aphasia. We think that evaluating recovery from aphasia may have great value if performed in the early stages after stroke.
The authors reported that the contralateral activation in homologous areas of speech processing and the perilesional activation in the ipsilateral speech areas may have value for recovery from aphasia, and we also have the same opinion about the improvement process.
Age was reported the most valuable parameter for recovery from aphasia by Kastrau et al, but the mean age of the elderly patients was 43.9±5.2 years. Although the mean age of our patients (53.7±7.5 years) was older than Kastrau’s patients, evident recovery from aphasia was observed in our patients after six months.
Although the study of Kastrau et al is the first study about the recovery from aphasia after decompressive surgery, a study that also evaluates the other factors affecting cerebral perfusion (eg, the duration from the event to the surgery, stroke severity at the time of surgery, and the discovery of herniation) may have more value.
Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke. 1998: 29: 1888–1893.
Kastrau F, Wolter M, Huber W, Block F. Recovery from aphasia after hemicraniectomy for infarction of the speech-dominant hemisphere. Stroke. 2005; 36: 825–829.