Abstract
Background and Objectives: Aphasia after spontaneous intracerebral haemorrhage (sICH) may result from cortical injury or disruption of subcortical language networks. This review summarises language phenotypes, recovery, prognostic factors, and evidence on hematoma evacuation.
Methods: Haemorrhage-specific studies reporting language outcomes were systematically reviewed, with mixed-stroke cohorts used for contextual recovery data. Language-specific surgical evidence was analysed separately from trials reporting global disability; owing to heterogeneity, findings were synthesised narratively.
Results: Putaminal and thalamic haemorrhages produced heterogeneous fluent and non-fluent aphasic syndromes. Longitudinal putaminal studies indicate that the largest gains usually occur within the first three months, while extensive corona-radiata/internal-capsule involvement and ventricular extension are associated with poorer recovery. One retrospective study reported better six-month language outcomes after endoscopic evacuation than craniotomy, but no conservative-treatment arm was included. Major randomised ICH surgery trials primarily measured global disability rather than aphasia. Bilingual haemorrhage reports showed parallel or differential impairment and recovery across languages.
Conclusions: Language outcome after sICH depends on lesion topography and network disruption. Recovery is greatest early, whereas a language-specific benefit from hematoma evacuation remains unproven.
