Cortical abnormalities and language function in young patients with basal ganglia stroke.

We examined MRI abnormalities and language function in young patients with infarctions apparently confined to the basal ganglia to establish whether impaired performance was attributable to basal ganglia damage per se or to additional cerebral abnormalities. Seventeen stroke patients (10 with left- and 7 with right-hemispheric damage) and seventeen controls participated. MRI included perfusion imaging and voxel-based morphometry analyses of T1-weighted and diffusion data sets. Language was assessed using the CELF-III test. Analysis of CELF-III scores showed a main effect of presence or absence of stroke, with patients performing more poorly than controls. There was no evidence of differences between the left- and right-hemisphere groups. However individual patients with left-hemisphere lesions showed large variations in performance. In the patients with left-hemisphere damage, voxel-based morphometry showed significant relationships between language function and gray matter density in cortical language areas. The white matter analyses also showed correlations with language function, and in addition there were hemodynamic abnormalities in cortical language areas in the three patients with poorest language function. We suggest that language impairments following basal ganglia damage may be attributable primarily to abnormalities in cortical language areas that are too subtle to detect on conventional structural MRI.