Aphasia associated with verified subcortical lesions: three case reports

Area of Science:

• Neurology
• Neuroscience
• Speech-Language Pathology

Background:

• Aphasia is traditionally linked to dominant hemisphere cortical damage.
• Internal capsule lesions were thought to cause only motor deficits and dysarthria.
• Recent literature suggests subcortical lesions, including in the putamen and internal capsule, can cause aphasia.

Observation:

• This study presents three clinical cases of aphasia stemming from left subcortical lesions.
• Lesions were confirmed via computed tomographic (CT) scans.
• Language deficits were objectively assessed using the Porch Index of Communicative Ability (PICA).

Findings:

• Two of the three patients demonstrated excellent recovery of language abilities.
• This suggests subcortical lesions might offer a better prognosis for aphasia recovery compared to cortical lesions.
• The favorable recovery may be associated with disruption of fiber pathways rather than direct cortical destruction.

Implications:

• Subcortical lesions should be considered in the differential diagnosis of aphasia.
• Understanding the mechanisms of recovery from subcortical aphasia can inform therapeutic strategies.
• Further research into the role of white matter tracts in aphasia recovery is warranted.