Excellent recovery of aphasia in a patient with complete injury of the arcuate fasciculus in the dominant hemisphere.

The arcuate fasciculus (AF) is the neural tract that connects Wernicke's area and Broca's area. The main role of the AF is speech repetition; therefore, injury to the AF typically causes conduction aphasia. We report on a patient who showed excellent recovery of aphasia despite complete injury of the AF due to a cerebral infarct. A 54-year-old, right-handed male presented with aphasia and right hemiparesis. Brain MRI showed an infarct in the left centrum semiovale and corona radiata. Diffusion tensor tractography for the AF was reconstructed using DTI-studio software. The Korean-Western Aphasia Battery (K-WAB) was used for measurement of language function. On K-WAB at 1 week after onset, his aphasia type was compatible with global aphasia (aphasia quotient: 12‰, fluency: 5‰, comprehension: 24‰, repetition: 15‰, and naming: 31‰). The patient underwent rehabilitative therapy, including language therapy and medication, which is known to facilitate recovery from aphasia, for a period of 24 months. His aphasia had improved to a nearly normal state at 30 months after onset; aphasia quotient: 93‰ (fluency: 91‰, comprehension: 92‰, repetition: 85‰, and naming: 96‰). The left AF showed a complete disruption on 27-month diffusion tensor tractography. Findings from this study suggest the possibility that aphasia might show good recovery, even in cases of severe injury of the AF.