| Background and Purposes:Mounting evidence suggested that subcortical lesions might also cause aphasia.Post-stroke basal ganglia aphasia is a common disease on clinic.Compared to cortical aphasia,these patients had milder language impairments,rapider recovery and better prognosis,which suggested basal ganglia aphasia might have different mechanisms of anatomical structure damage and functional remodeling rehabilitation.There are dense white matter tracts in the basal ganglia.And functional tracts damage is an important anatomical structural basis for the occurrence of basal ganglia aphasia.These purposes of this study were to investigate the clinical characteristics of basal ganglia aphasia,and observe changes in microstructural integrity of language-related white matter tracts within 7 days and 3 months after onset by diffusion spectrum imaging(DSI)tractography and its correlations with clinical manifestation of aphasia.Materials and Methods:In this study,19 patients(13 males and 6 females)with basal ganglia aphasia after stroke were collected according to strict inclusion and exclusion criteria.9healthy volunteers were matched for gender,age,and years of education.All patients were diagnosed with ischemic stroke with lesions confined to the basal ganglia by CT or MRI.In addition,no structural damage was observed in the cortical language areas.19 patients received the Aphasia Battery of Chinese(ABC)for language function assessment and neuropsychological assessment,and received MRI scanning to obtain brain DSI data within 7 days after the onset.4 patients in the aphasia group underwent the second scale assessment and DSI examination 90+7 days after the onset.Healthy volunteers only had one scale assessment and DSI data collection.The DSI scanning data was reconstructed by generalized q-sampling imaging(GQI).Then we applied DSI studio and used deterministic fiber-tracking algorithm to reconstruct the bilateral arcuate fasciculus(AF),superior longitudinal fasciculus(SLF),inferior fronto-occipital fasciculus(IFOF),middle longitudinal fasciculus(Md LF),inferior longitudinal fasciculus(ILF),uncinate fasciculus(UF),frontal aslant tracts(FAT),superior corticostriatal tracts,and corpus callosum(CC).And we measured quantitative anisotropy(QA)of each white matter tracts.These data were analyzed statistically.4 follow-up patients were also performed with differential tractography.Correlation tractography were used to analyze the correlations between QA and clinical scale scores in the aphasia group.Results:1.Within 7 days after the onset of post-stroke basal ganglia aphasia,fluency,comprehension,naming,reading,AQ,MMSE,and Mo CA scores were significantly lower than healthy controls’(P<0.001).HAMA-17,HAMD-17 and PHQ-9 scores were significantly higher than healthy controls’(P< 0.001,P=0.006,P=0.039).Repetition scores were lower and the GAD-7 scores were higher than healthy controls’,and none of the differences were statistically significant(P>0.05).2.3 months after onset,fluency,comprehension,and AQ scores of patients’ language were statistically higher than those within 7 days after onset(P < 0.05).Repetition,naming,reading,MMSE,and Mo CA scores were higher than those within7 days after onset,with no statistically significant difference(P>0.05).And GAD-7,PHQ-9,HAMA-17,and HAMD-17 scores were lower than those within 7 days after onset,with no statistically significant difference(P>0.05).3.Compared with the healthy controls,the QA values of corpus callosum body fibers,left AF,left SLF II,left SLF III,left Md LF,left IFOF,left FAT,right FAT,and left superior corticostriatal tracts had statistically reductions in the aphasia group within 7 days of onset(P<0.05).4.Based on individual difference tractography analysis,QA values of the partial corpus callosum forceps major,partial corpus callosum body fibers,left SLF,and left AF were lower 3 months after onset than within 7 days of onset(FDR<0.05).And the QA values of partial corpus callosum body fibers,partial corpus callosum forceps major,right SLF,and right IFOF were statistically higher 3 months after onset than within 7 days of onset(FDR<0.05).5.The QA values of left AF,left SLF II,right Md LF,left UF,and left superior corticostriatal tracts were positively correlated with naming scores,and the differences were statistically significant(P<0.05).Conclusions:1.Post-stroke basal ganglia aphasia was characterized with preserved repetition and impairments of fluency,comprehension,naming,reading,and cognitive ability.Fluency and comprehension were restored in the subacute phase.2.The impaired integrity of corpus callosum body fibers and other language-related white matter tracts might be the functional anatomical mechanism leading to the basal ganglia aphasia after stroke.Impaired integrity of white matter tracts such as the left AF might lead to naming dysfunction.3.In the subacute phase,the white matter tracts of left hemisphere were continuously disrupted and the recovery of language function might be based on the remodeling of right white matter tracts. |
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