eMedicine Specialties > Neurology > Behavioral Neurology and Dementia

Aphasia: Differential Diagnoses & Workup

Author: Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Coauthor(s): Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Contributor Information and Disclosures

Updated: Jul 17, 2009

Differential Diagnoses

Anterior Circulation Stroke
Glioblastoma Multiforme
Cardioembolic Stroke
Head Injury
Central Pontine Myelinolysis
Low-Grade Astrocytoma
Cerebral Venous Thrombosis
Multiple Sclerosis
CNS Melanoma
Posterior Cerebral Artery Stroke
Dementia in Motor Neuron Disease
Status Epilepticus
Dissection Syndromes
Frontal and Temporal Lobe Dementia
Frontal Lobe Syndromes

Other Problems to Be Considered

Developmental disorder
Encephalopathy/delirium
Locked-in state (due to central pontine myelinolysis)
Mutism
Psychiatric disease

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. 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.

Other Tests

  • EEG is important in patients with suspected seizures.
  • Neuropsychological testing and speech therapy evaluation are helpful for guiding therapy for aphasia.

More on Aphasia

Overview: Aphasia
Differential Diagnoses & Workup: Aphasia
Treatment & Medication: Aphasia
Follow-up: Aphasia
References
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Further Reading

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Keywords

aphasia, disorder of language, language disorder, language dysfunction, inability to speak, brain damage, brain injury, left cerebral hemisphere, alexia, disorder of reading, agraphia, disorder of writing, apraxia, buccofacial apraxia, disorder of skilled movements, aphasia, fMRI

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Contributor Information and Disclosures

Author

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Coauthor(s)

Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Daniel H Jacobs, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Society for Neuroscience
Disclosure: Teva Pharmaceutical Grant/research funds Consulting; Biogen Idex Grant/research funds Independent contractor; Serono EMD Royalty Speaking and teaching; Pfizer Royalty Speaking and teaching; Berlex Royalty Speaking and teaching

Medical Editor

Joseph Quinn, MD, Assistant Professor, Department of Neurology, Portland VA Medical Center, Oregon Health Sciences University
Joseph Quinn, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Medivations Honoraria Consulting

 
 
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