There is no sufficient data about aphasia epidemiology in Egypt, and few studies was conducted about that but in this study relative frequency of PSA in Assiut University Hospital was 7.1%, and this nearly agreed with El-Tallawy and colleagues, 2015, a previous study done at Assiut, which reported PSA among 6.7% of stroke patients .
In present study, aphasia was more common among male patients (57.9%) than among female patients (42.1%) and this was consistent with Gerges . On the other hand, Engelter and colleagues , Kyrozis and colleagues , and Sinanović and colleagues  reported that aphasia was more frequent among females. However Kang and colleagues reported no sex difference in the incidence of aphasia . In the present study, aphasia was more among males which can be explained that stroke patients who were admitted to Assiut University Hospital during the time of study were more males.
In present study, there was no significant difference between males and females regarding clinical types of aphasia. This was consistent with other studies that reported there was no association between gender and aphasia type specifically, Godefroy and colleagues  and Engelter and colleagues  who observed no gender differences on measures of auditory comprehension and expressive language.
In present study, there was no significant difference between males and females regarding initial aphasia score or rate of recovery and that could be explained that both genders have the same mechanisms for aphasia recovery as regards the restoration of brain perfusion or neuroplasticity changes in the brain . This was consistent with studies by Inatomi and colleagues , Seniow and colleagues , and Watila and colleague  that reported no gender difference in aphasia recovery.
The studied patients were classified into two groups, aphasia with repetitive disorder (79.4%) “Including global, Broca’s, Wernicke, conduction aphasia and aphemia” and aphasia without repetitive disorder (20.6%) “Including striatal, thalamic, mixed transcortical, transcortical motor, transcortical sensory and anomia”.
The most frequent type of aphasia was global aphasia (66.4%), followed by striatal (11.2%), Broca’s (8.4%), thalamic (4.7%), Wernicke (2.8%), mixed transcortical (1.9%), conduction, transcortical motor, transcortical sensory, anomia, and aphemia (0.9% for each type of them). Many other studies had variable results regarding aphasia subtypes which could be attributed to variations in methodology.
The most frequent type of aphasia was global aphasia (66.4%) which could be explained that this study was carried out among the inpatients of Assiut University Hospital which is considered as a main center at Upper Egypt where most critical cases (as patients with global aphasia) are admitted because there is lack of neurology departments in Upper Egypt.
Higher score for repetition at the onset was reported for aphasia without repetitive disorder than aphasia with repetitive disorder, and there was better recovery during the follow-up in aphasia without repetitive disorder regarding repetition, comprehension, spontaneous speech, naming, reading, and writing. Then, comparative assessment was done between the most frequent three types of aphasia in the studied patients including global (66.4%), subcortical “Thalamic and striatal aphasia” (15.9%), and Broca’s aphasia (8.4%).
These results revealed that the highest initial mean score at the onset was for Broca’s aphasia while the best recovery during the follow-up (regarding repetition, comprehension, spontaneous speech, naming, reading, and writing) was for subcortical aphasia (p = 0.000) then Broca’s aphasia, with the least recovery for global aphasia.
This was consistent with Pedersen and colleagues, and Jung and colleagues who observed that those with global aphasia had poorer recovery than those with other aphasia types, which may reflect higher stroke severity and extensive lesions that affect brain areas responsible for language process [24, 25] .Also Kang and colleagues reported better recovery in patients with subcortical aphasia which can be explained that patients with subcortical aphasia have preserved cortical structures with their ability for neuroplasticity changes that can help for aphasia recovery .
In comparing demographic, clinical, and neuroimaging data regarding the rate of recovery of aphasia in the follow-up study, it was reported that there were many prognostic factors that can predict rate of aphasia recovery.
There was no significant difference between different age groups regarding initial aphasia score at the onset. This was consistent with Kang and colleagues who found no difference between age and initial aphasia severity , but better recovery during follow-up was reported among younger age groups (p = 0.041) which can be explained that older patients had structural changes through aging process that impair mechanisms of aphasia recovery. This was consistent with Laska and colleagues and Watila and colleague who reported that there is a tendency for older patients to have a poorer recovery [23, 26], while other studies such as Inatomi and colleagues  reported age as a not significant prognostic indicator for aphasia recovery which could be explained by short follow-up period in their study.
Better recovery was reported with hemorrhagic stroke more than ischemic stroke (p = 0.010 after one month and p = 0.019 after three months). This was consistent with Jung and colleagues who found that hemorrhagic stroke survivors had a better prognosis than ischemic stroke patients. The better prognosis may be due to fiber bundles being displaced without damage in hemorrhagic strokes .
In the present study, there was a negative correlation between the size of cerebral infarction and recovery rate as better recovery was for small-sized infarction (p = 0.031). This was consistent with Maas and colleagues  and Henseler and colleagues  who reported the negative influence of larger lesion on PSA recovery.
The limitation of this study is that a larger sample size with longer duration follow-up can be included with further assessment with functional neuroimaging to study the role of cerebral hemispheres in language recovery.