Regional metabolic correlates of Token test results in cortical and subcortical left hemispheric infarction

We investigated 26 right-handed patients who had aphasia caused by a single infarct in the territory of the left middle cerebral artery (MCA) with cranial CT, positron emission tomography, and a standard language test battery including the Token test. The patients represented an unselected sample of various infarct locations within the left MCA territory and showed a wide range of aphasia types and severity. Stepwise regression analysis revealed that Token test performance mainly depended on parietotemporal metabolism, irrespective of infarct location. Frontal and basal ganglia metabolism did not contribute significantly to Token test performance. These results suggest that disturbance of language comprehension is due to parietotemporal cortical dysfunction in all types of left MCA infarction. Infarcts restricted to basal ganglia or the anterior part of the MCA territory apparently do not disturb language comprehension directly, but via their remote effects on parietotemporal metabolism.