The anatomy of aphasia revisited

Objective: To determine lesion locations associated with the various types of aphasic disorders in patients with stroke. Background: The anatomy of ap hasia has been challenged by several recent studies. Discrepancies are like ly to be due to methodologic issues. Methods: We examined 107 patients with a standardized aphasia battery and MRI. Three examiners blinded to the cli nical data rated signal abnormalities in 69 predetermined regions of intere st. The statistical procedure used classification tree testing, which selec ted regions associated with each aphasic disorder. Results: 1) Nonfluent ap hasia depended on the presence of frontal or putaminal lesions; 2) repetiti on disorder on insula-external capsule lesions; 3) comprehension disorder o n posterior lesions of the temporal gyri; 4) phonemic paraphasia on externa l capsule lesions extending either to the posterior part of the temporal lo be or to the internal capsule; 5) verbal paraphasia on temporal or caudate lesions; and 6) perseveration on caudate lesions. These analyses correctly classified 67% to 94% of patients. Conclusions: Lesion location is the main determinant of aphasic disorders at the acute stage. Most clinical-radiolo gic correlations supported the classic anatomy of aphasia.