Aphasia Workup: Laboratory Studies, Imaging Studies, Other Tests

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Aphasia

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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.^[20]

Other Tests

See the list below:

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

Treatment & Management

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