Unexpected recovery of language function after massive left-hemisphere infarct: Coordinated psycholinguistic and neuroimaging studies

This case study exploits recent advances in analysis of language disorder and neuroimaging technique to revisit issues of assessment, localization of function, plasticity, and recovery of function. We tested the limits of spared language capacities and investigated the neural basis of sparing in three cases of large left-hemisphere infarct resulting from stroke that had occurred more than 10 years earlier. Lesion analysis implicated Broca’s and Wernicke’s areas and other structures within the distribution of the middle cerebral artery. Each case shows significant recovery of function in the face of massive damage to the left hemisphere. HW, age 65, is a high-school educated male. JN, age 80, and BN, age 62, are college-educated females. HW and JN were right handed prior to stroke; BN was ambidextrous. Each case presents a left-sided lesion implicating portions of inferior frontal, dorsolateral frontal, pre- and post-central region, insula, inferior parietal, superior temporal, as well as some subcortical structures; in one case (BN) a small area of subcortical infarction is also present in the right hemisphere.