Language dysfunction in white matter: Lesions without significant hemiparesis

Abstract

Subcortical lesions associated with aphasia are usually associated with concomitant neurologic deficits. Five patients with subcortical aphasia with purely white matter involvement and without significant hemiparesis were studied in relation to the severity of the aphasia, size.and site of the cerebral lesion, and outcome of the aphasia. The severity of the aphasia was determined by the Boston Diagnostic Aphasia Examination (BDAE). All patients had CCT. In four patients the lesions were located in the superior and/or anterior superior periventricular white matter (PVWM) and in the remaining one in the extra-anterior PVWM and posterior extension of PVWM. Three patients had characteristics of global aphasia, one had mixed transcortical aphasia, and one had Wernicke's aphasia. Coexistent disorders were dysarthria and dysgraphia in four patients and hypophonia in one. Language recovery was good in two patients with mixed transcortical and fluent aphasia and moderate to poor in the remaining three, two of whom had prolonged dysphagia. The initial severity of the aphasia was predictive of outcome. The localization of the lesions was more important in prognosis than lesion size. Prolonged dysphagia was associated with a poor prognosis. © 1996 Demos Vermande.