Aphasia following striatocapsular infarction may be explained by concomitant small cortical infarct on diffusion-weighted imaging.
BACKGROUND
The underlying mechanism of aphasia following striatocapsular infarction (SCI) remains controversial. We hypothesized that aphasia resulting from SCI might be associated with concomitant cortical lesions, which can be demonstrated by diffusion-weighted imaging (DWI).


METHODS
We analyzed 24 patients with left SCI who underwent DWI and MR angiography within 2 days after the onset. Aphasia was assessed by the modified Korean version of the Boston Diagnostic Aphasia Examination test.


RESULTS
DWI showed the presence of additional ischemic lesions involving the cortical areas in 13 of 24 SCI patients (54%). Ten patients (42%) showed aphasia. All 10 patients with aphasia had cortical lesions in addition to SCI (p = 0.0002), whereas 21% (3/14) of the nonaphasic patients had additional cortical lesions. Conventional MRI did not reveal the presence of corresponding acute cortical lesions in any of the aphasic patients. There was no difference between the patients with and without aphasia in terms of their stroke etiology.


CONCLUSIONS
Our data suggest that aphasia due to SCI in the acute stage may be attributed to direct cortical injury, whose presence can be demonstrated by DWI, even though it might be invisible on conventional imaging.
Han
Moon-Ku
MK
Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea. rohjk@snu.ac.kr
Kang
Dong-Wha
DW
Jeong
Sang-Wuk
SW
Roh
Jae-Kyu
JK
D000368:Aged; D001037:Aphasia / Q000209:etiology / Q000473:pathology*; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology*; D003342:Corpus Striatum / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020772:Internal Capsule / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013687:Telencephalon / Q000473:pathology*