Aphasia with predominantly subcortical lesion sites: description of three capsular/putaminal aphasia syndromes

Nine cases of subcortical aphasia with capsular/putaminal (C/P) lesion sites demonstrated on computed tomographic (CT) scans were studied. Eight cases were occlusive-vascular in etiology and one was hemorrhagic. Three subcortical aphasia syndromes and three C/P lesion site patterns were observed. Patients with C/P lesion sites with anterior-superior white-matter lesion extension had good comprehension, grammatical, but slow, dysarthric speech, and lasting right hemiplegia. Patients with C/P lesion sites with posterior white-matter lesion extension across the auditory radiations in the temporal isthmus had poor comprehension, fluent Wernicke-type speech, and lasting right hemiplegia. Patients with C/P lesion sites with both anterior-superior and posterior extension were globally aphasic and had lasting right hemiplegia. Although these cases of C/P subcortical aphasia shared certain well-known features of Broca's and Wernicke's cortical aphasia syndromes, they did not completely resemble cases of either Broca's, Wernicke's, global, or thalamic aphasia in neurologic findings, CT scan lesion sites, or language behavior. Further study of the subcortical aphasias associated with these C/P lesion sites seems to be warranted.