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Background: The pattern of post-stroke aphasia in speakers of Bengali language has not previously been reported in the literature. Furthermore, the inter-relationship between age, gender, and level of education and aphasia typology has remained unsettled thus far. Aims: To investigate the incidence and type of aphasia in first-ever acute stroke patients who were speakers of Bengali language. Methods & Procedures: Bengali version of Western Aphasia Battery was used for language assessment in our study participants. Lesion localization was done by using magnetic resonance imaging(3T) for ischemic stroke (if not contraindicated) and computed tomography for hemorrhagic stroke. Among 515 screened cases of first-ever acute stroke, 208 presented with aphasia. Language assessment was done between 7 and 14 days in all study participants. Outcomes & Results: The incidence of post-stroke aphasia in our sample was found at 40.39%. Types of aphasia were – Broca's (38.5%) followed by global (27.9%); Wernicke's (12.5%); transcortical motor (9.6%); anomic (4.3%); transcortical sensory (3.8%); isolation (1.9%); and conduction (1.4%). Mean number of years of formal education was significantly higher in fluent aphasia group in comparison with non-fluent group (10.51 years versus 7.01 years, p = 0.003). In logistic regression analysis, location of lesion (posterior perisylvian) (p = 0.007, OR = 5.406, 95% CI, 1.602–18.240) and education (p = 0.044, OR = 1.097, 95% CI, 1.003–1.199) were two independent predictors favoring fluent aphasia. Conclusions: Aphasia among post-stroke Bengali patients is quite frequent. The commonest type of aphasia in our sample was Broca's aphasia. Bengali-speaking people with higher education were more likely to present fluent aphasia. [ABSTRACT FROM AUTHOR]

Contemporary research papers have highlighted the issue of lesion-aphasia discordance in reference to the classic 'associationist' model provided by Wernicke-Lichtheim. The objective of the present study is to explore frequency, pattern and evolution of lesion-discordant aphasia following first ever acute stroke in Bengali-speaking subjects. Bengali version of Western Aphasia Battery, a validated scale, was used for language assessment in our study subjects. Lesion localization was done by using Magnetic resonance imaging (MRI) (3T) for ischemic stroke (if not contraindicated) and computed tomography (CT) for hemorrhagic stroke. Among 515 screened cases of first-ever acute stroke, 208 presented aphasia. Language assessment was done between 7 and 14 days in all study subjects and was repeated between 90 and 100 days in patients available for follow-up. Ischemic stroke cases with contraindication for MRI underwent CT imaging. Discordance between lesion and aphasic phenotype was determined only for right-handed subjects with cortical involvement (isolated or in combination with sub-cortical white matter) in the left hemisphere. Appropriate statistical tests were used to analyze the collected data. Lesion-aphasia discordance was found in 20 out of 134 patients with aphasia who were dextral and had cortical involvement in the left hemisphere (14.92%). The pattern of discordance observed were- posterior lesion with Broca's aphasia (4; 20%); posterior lesion with global aphasia (8; 40%); anterior lesion with global aphasia (4; 20%), and posterior lesion with mixed transcortical aphasia (4; 20%). On univariate analysis, the factors significantly associated with lesion-aphasia discordance were hemorrhagic stroke (p = 0.000); posterior perisylvian location (p = 0.002), and higher education (p = 0.048). After adjusting for all other variables, hemorrhagic stroke was found to have strong association with lesion-aphasia discordance (p = 0.001, OR = 11.764, 95% CI, 2.83–50.0). Discordant cases were more likely to recover or change to a milder type compared to concordant cases (p = 0.007, OR = 11.393, 95% CI, 1.960–66.231), after adjusting for all other variables including initial severity of aphasia (p = 0.006, OR = 8.388, 95% CI, 1.816–38.749). Lesion-aphasia discordance following acute stroke is not uncommon among Bengali-speaking subjects. In the discordant group, preponderance towards non-fluent aphasia was observed. Discordance occurred more frequently after hemorrhagic stroke. Subjects with lesion-discordant aphasia presented better recovery during early post-stroke phase. • Among 515 screened cases of first-ever acute stroke, 208 presented aphasia. • Lesion-aphasia discordance was found in 20 (14.92%) patients. • Hemorrhagic stroke was found to have strong association with lesion-aphasia discordance. • Discordant cases were more likely to recover or change to a milder type [ABSTRACT FROM AUTHOR]