Aphasia associated with lacunar infarctions

Abstract

Background: Typical lacunar syndromes do not include aphasia but aphasia has been reported in rare atypical lacunar syndromes. Objective: Description of the phenomenology and of affected fiber tracts. Material and methods: Case series of three patients with lacunar stroke as evidenced by magnetic resonance imaging. Identification of affected fiber tracts via fiber tracking from coregistered lesion sites in brains of two healthy participants. Results: The lacunar strokes that produced aphasia were located in the very lateral territory of perforating branches of the middle cerebral artery and extended along the external capsule into its most rostrodorsal aspect. Even though the cortex, thalamus and most parts of the basal ganglia were unaffected, patients exhibited a mild to moderate nonfluent aphasia with syntactic deficits. Fiber tracking revealed that in contrast to the nonaphasic control patient with a neighboring lacunar stroke, the aphasic patient strokes involved particularly fibers of the left arcuate fascicle as well as fibers of the frontostriatal and frontal aslant tracts. Conclusion: Left lateral lacunar stroke can cause clinically relevant aphasia through disruption of speech-relevant fiber tracts.