The extreme capsule and aphasia: proof-of-concept of a new way relating structure to neurological symptoms

Ariane Martinez Oeckel; Michel Rijntjes; Volkmar Glauche; Dorothee Kümmerer; Christoph P Kaller; Karl Egger; Cornelius Weiller

doi:10.1093/braincomms/fcab040

The extreme capsule and aphasia: proof-of-concept of a new way relating structure to neurological symptoms

Brain Commun. 2021 Mar 14;3(2):fcab040. doi: 10.1093/braincomms/fcab040. eCollection 2021.

Authors

Ariane Martinez Oeckel¹, Michel Rijntjes¹, Volkmar Glauche¹, Dorothee Kümmerer¹, Christoph P Kaller², Karl Egger², Cornelius Weiller¹

Affiliations

¹ Department of Neurology and Clinical Neurosciences, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany.
² Department of Neuroradiology, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany.

Abstract

We present anatomy-based symptom-lesion mapping to assess the association between lesions of tracts in the extreme capsule and aphasia. The study cohort consisted of 123 patients with acute left-hemispheric stroke without a lesion of language-related cortical areas of the Stanford atlas of functional regions of interest. On templates generated through global fibre tractography, lesions of the extreme capsule and of the arcuate fascicle were quantified and correlated with the occurrence of aphasia (n = 18) as defined by the Token Test. More than 15% damage of the slice plane through the extreme capsule was a strong independent predictor of aphasia in stroke patients, odds ratio 16.37, 95% confidence interval: 3.11-86.16, P < 0.01. In contrast, stroke lesions of >15% in the arcuate fascicle were not associated with aphasia. Our results support the relevance of a ventral pathway in the language network running through the extreme capsule.

Keywords: aphasia; arcuate fascicle; dual pathway model; extreme capsule; stroke.