Northam, GB; Adler, S; Eschmann, KCJ; Chong, WK; Cowan, FM; Baldeweg, T; (2018) Developmental conduction aphasia after neonatal stroke. Annals of Neurology , 83 (4) pp. 664-675. 10.1002/ana.25218.

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Abstract

OBJECTIVE: Impairment of speech repetition following injury to the dorsal language stream is feature of conduction aphasia - a well-described 'disconnection syndrome' in adults. The impact of similar lesions sustained in infancy has not been established. METHODS: We compared language outcomes in term-born individuals with confirmed neonatal stroke (n=30; age: 7-18 years, left-sided lesions in 21 cases) to matched controls (n=40). Injury to the dorsal and/or ventral language streams was assessed using T1- and T2-weighted MRI and diffusion tractography. Language lateralization was determined using functional MRI. RESULTS: At the group level, left dorsal language stream injury was associated with selective speech repetition impairment for non-words (p=0.021) and sentences (p<0.0001). The majority of children with significant repetition impairment had retained left hemisphere language representation, but right hemisphere dominance was correlated with minimal or absent repetition deficits. Post-hoc analysis of the repetition-impaired group revealed additional language-associated deficits, but these were more subtle and variable. INTERPRETATION: We conclude that (i) despite the considerable plasticity of the infant brain, early dorsal language stream injury can result in specific and long-lasting problems with speech repetition that are similar to the syndrome of conduction aphasia seen in adults, and that (ii) language reorganization to the contralateral hemisphere has a protective effect.

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