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Improved Recovery Observed With Subcortical Temporal Isthmus Lesion vs Wernicke's Cortical Area Lesion

Margaret A. Naeser, PhD; Ann Gaddie, MS; Carole L. Palumbo; Denise Stiassny-Eder, MS

Arch Neurol. 1990;47(4):425-432.

Abstract
• This study examined the relationship between recovery of auditory comprehension in global aphasia patients after 1 year post onset, and temporal lobe lesion in Wernicke's cortical area vs temporal lobe lesion in the subcortical temporal isthmus area. Computed tomographic scans and language behavior were examined in 14 right-handed globally aphasic stroke patients with lesion in the left hemisphere. Nine patients had large cortical subcortical frontal, parietal, and temporal lobe lesion that included more than half of Wernicke's cortical area (FPT cases). Five patients had large cortical/subcortical frontal and parietal lobe lesion, but only subcortical temporal lobe lesion, including the temporal isthmus (FPTi cases). All patients were tested acutely at 1 to 4 months post onset and again at 1 to 2 years post onset. There was a significantly greater increase in the amount of recovery that had taken place after 1 to 2 years post onset for the FPTi group vs the FPT group in the overall Boston Diagnostic Aphasia Examination (BDAE) Auditory Comprehension Zscore. In four of the five FPTi cases, the late BDAE Auditory Comprehension Z scores were above –0.5 (mild-to-moderate comprehension deficits). Most recovery was in single-word comprehension. In eight of the nine FPT cases, the late BDAE Auditory Comprehension Z-scores were below –0.5 (moderate-to-severe comprehension deficits). There was no significant difference between the two groups in recovery of spontaneous speech, repetition, or naming, where severe deficits remained in most cases. Careful examination of the type of temporal lobe lesion (cortical vs subcortical) appears relevant for predicting potential for recovery of some auditory language comprehension (especially single-word comprehension) in some global aphasia patients after 1 year post onset.

Author Affiliations
From the Aphasia Research Center and the Department of Neurology, Boston (Mass) University School of Medicine and Boston Veterans Administration Medical Center (Dr Naeser and Mss Palumbo and Stiassny-Eder), and the Department of Communication Disorders and Sciences, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill (Ms Gaddie).

Footnotes
Accepted for publication August 30, 1989.

Read before the American Speech, Language, and Hearing Association meetings, New Orleans, La, November 14,1987, and at the Clinical Aphasiology Conference, Harwich Port, Mass, June 22, 1988.

Reprint requests to Veterans Administration Medical Center (116-B), 150 S Huntington Ave, Boston, MA 02130 (Dr Naeser).

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