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.

ZUSAMMENFASSUNG: HINTERGRUND: Aphasien gehören nicht zu den typischen klinischen Manifestationen lakunärer Hirninfarkte, sind jedoch im Rahmen seltener atypischer lakunärer Syndrome beschrieben. ZIEL DER ARBEIT: Beschreibung von Aphasiemustern und betroffener Fasertrakte bei lakunären Infarkten. MATERIAL UND METHODEN: Fallserie von drei Patienten mit in der Magnetresonanztomographie nachgewiesenen lakunären Hirninfarkten und Aphasie. Identifikation betroffener Faserbahnen mittels Fasertraktographie der koregistrierten Schädigungsorte in Gehirnen zweier gesunder Probanden. ERGEBNISSE: Radiologisch waren die Lakunen, die Aphasien hervorriefen, weit lateral im Marklager der linken Hemisphäre gelegen und befanden sich im Vergleich zu der Lakune eines nichtaphasischen Kontrollpatienten weiter rostrodorsal. Klinisch fand sich trotz Aussparung des Kortex, Thalamus und weiter Teile der Basalganglien eine leichte bis moderate nichtflüssige Aphasie mit syntaktischen Defiziten. In der Fasertraktographie zeigten die aphasischen im Vergleich zum nichtaphasischen Patienten eine stärkere Affektion der Fasern des linken Fasciculus arcuatus sowie eine Beteiligung des frontostriatalen und frontalen Aslant-Trakts. DISKUSSION: Links lateral gelegene lakunäre Infarkte können durch Beteiligung sprachrelevanter Fasertrakte eine klinisch relevante Aphasie hervorrufen.

Institut für Neuroradiologie Goethe Universität Frankfurt Frankfurt Deutschland

Klinik für Neurologie Goethe Universität Frankfurt Schleusenweg 2 16 60528 Frankfurt Deutschland

Klinik für Neurologie Universitätskrankenhaus Olomouc und Fakultät der Medizin und Zahnmedizin Palacký Universität Olomouc Tschechien

Zobrazit více v PubMed

Alexander MP, Naeser MA, Palumbo CL. Correlations of subcortical CT lesion sites and aphasia profiles. Brain. 1987;110(Pt 4):961–991. doi: 10.1093/brain/110.4.961. PubMed DOI

Arboix A, López-Grau M, Casasnovas C, et al. Clinical study of 39 patients with atypical lacunar syndrome. J Neurol Neurosurg Psychiatry. 2006;77(3):381–384. doi: 10.1136/jnnp.2005.071860. PubMed DOI PMC

Barow E, Boutitie F, Cheng B, et al. Functional outcome of intravenous thrombolysis in patients with lacunar infarcts in the WAKE-UP trial. JAMA Neurol. 2019;76(6):641–649. doi: 10.1001/jamaneurol.2019.0351. PubMed DOI PMC

Behrens TEJ, Woolrich MW, Jenkinson M, et al. Characterization and propagation of uncertainty in diffusion-weighted MR imaging. Magn Reson Med. 2003;50(5):1077–1088. doi: 10.1002/mrm.10609. PubMed DOI

Behrens TEJ, Johansen-Berg H, Woolrich MW, et al. Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging. Nat Neurosci. 2003;6(7):750–757. doi: 10.1038/nn1075. PubMed DOI

Behrens TEJ, Berg HJ, Jbabdi S, et al. Probabilistic diffusion tractography with multiple fibre orientations: What can we gain? Neuroimage. 2007;34(1):144–155. doi: 10.1016/j.neuroimage.2006.09.018. PubMed DOI PMC

Benjamin P, Lawrence AJ, Lambert C, et al. Strategic lacunes and their relationship to cognitive impairment in cerebral small vessel disease. Neuroimage Clin. 2014;4:828–837. doi: 10.1016/j.nicl.2014.05.009. PubMed DOI PMC

Damasio AR, Damasio H, Rizzo M, et al. Aphasia with nonhemorrhagic lesions in the basal ganglia and internal capsule. Arch Neurol. 1982;39(1):15–24. doi: 10.1001/archneur.1982.00510130017003. PubMed DOI

Fisher CM. Lacunar strokes and infarcts: a review. Neurology. 1982;32(8):871–876. doi: 10.1212/WNL.32.8.871. PubMed DOI

Fridriksson J, Guo D, Fillmore P, et al. Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia. Brain. 2013;136(Pt 11):3451–3460. doi: 10.1093/brain/awt267. PubMed DOI PMC

Fritsch M, Krause T, Klostermann F, et al. “Thalamic aphasia” after stroke is associated with left anterior lesion location. J Neurol. 2020;267(1):106–112. doi: 10.1007/s00415-019-09560-1. PubMed DOI

Fure B, Bruun Wyller T, Engedal K, et al. Cognitive impairments in acute lacunar stroke. Acta Neurol Scand. 2006;114(1):17–22. doi: 10.1111/j.1600-0404.2006.00603.x. PubMed DOI

Graff-Radford NR, Damasio H, Yamada T, et al. Nonhaemorrhagic thalamic infarction. Clinical, neuropsychological and electrophysiological findings in four anatomical groups defined by computerized tomography. Brain. 1985;108(Pt 2):485–516. doi: 10.1093/brain/108.2.485. PubMed DOI

Huber W, Poeck K, Willmes K. The Aachen Aphasia Test. Adv Neurol. 1984;42:291–303. PubMed

Huber W, Poeck K, Springer L. Sprachstörungen. Stuttgart: Trias; 1991. p. 158.

Javad F, Warren JD, Micallef C, et al. Auditory tracts identified with combined fMRI and diffusion tractography. Neuroimage. 2014;84:562–574. doi: 10.1016/j.neuroimage.2013.09.007. PubMed DOI PMC

Jenkinson M, Smith S. A global optimisation method for robust affine registration of brain images. Med Image Anal. 2001;5(2):143–156. doi: 10.1016/S1361-8415(01)00036-6. PubMed DOI

Jenkinson M, Bannister P, Brady M, et al. Improved optimization for the robust and accurate linear registration and motion correction of brain images. Neuroimage. 2002;17(2):825–841. doi: 10.1006/nimg.2002.1132. PubMed DOI

Jenkinson M, Beckmann CF, Behrens TEJ, et al. FSL. Neuroimage. 2012;62(2):782–790. doi: 10.1016/j.neuroimage.2011.09.015. PubMed DOI

Kang EK, Sohn HM, Han M-K, et al. Subcortical aphasia after stroke. Ann Rehabil Med. 2017;41(5):725–733. doi: 10.5535/arm.2017.41.5.725. PubMed DOI PMC

Kinoshita M, de Champfleur NM, Deverdun J, et al. Role of fronto-striatal tract and frontal aslant tract in movement and speech: an axonal mapping study. Brain Struct Funct. 2015;220(6):3399–3412. doi: 10.1007/s00429-014-0863-0. PubMed DOI

Kümmerer D, Hartwigsen G, Kellmeyer P, et al. Damage to ventral and dorsal language pathways in acute aphasia. Brain. 2013;136(Pt 2):619–629. doi: 10.1093/brain/aws354. PubMed DOI PMC

Lauer N, Birner-Janusch B. Sprechapraxie im Kindes- und Erwachsenenalter. 2. Stuttgart: Thieme; 2010.

Smith SM, Jenkinson M, Woolrich MW, et al. Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage. 2004;23(Suppl 1):S208–S219. doi: 10.1016/j.neuroimage.2004.07.051. PubMed DOI

Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822–838. doi: 10.1016/S1474-4422(13)70124-8. PubMed DOI PMC

Yang H, Bai L, Zhou Y, et al. Increased inter-hemispheric resting-state functional connectivity in acute lacunar stroke patients with aphasia. Exp Brain Res. 2017;235(3):941–948. doi: 10.1007/s00221-016-4851-x. PubMed DOI

Yeh F-C, Verstynen TD, Wang Y, et al. Deterministic diffusion fiber tracking improved by quantitative anisotropy. PLoS One. 2013;8(11):e80713. doi: 10.1371/journal.pone.0080713. PubMed DOI PMC