Damage to white matter bottlenecks contributes to language impairments after left hemispheric stroke
Open accessAbstract
Damage to the white matter underlying the left posterior temporal lobe leads to deficits in multiple language functions. The posterior temporal white matter may correspond to a bottleneck where both dorsal and ventral language pathways are vulnerable to simultaneous damage. Damage to a second putative white matter bottleneck in the left deep prefrontal white matter involving projections associated with ventral language pathways and thalamo-cortical projections has recently been proposed as a source of semantic deficits after stroke. Here, we first used white matter atlases to identify the previously described white matter bottlenecks in the posterior temporal and deep prefrontal white matter. We then assessed the effects of damage to each region on measures of verbal fluency, picture naming, and auditory semantic decision-making in 43 chronic left hemispheric stroke patients. Damage to the posterior temporal bottleneck predicted deficits on all tasks, while damage to the anterior bottleneck only significantly predicted deficits in verbal fluency. Importantly, the effects of damage to the bottleneck regions were not attributable to lesion volume, lesion loads on the tracts traversing the bottlenecks, or damage to nearby cortical language areas. Multivariate lesion-symptom mapping revealed additional lesion predictors of deficits. Post-hoc fiber tracking of the peak white matter lesion predictors using a publicly available tractography atlas revealed evidence consistent with the results of the bottleneck analyses. Together, our results provide support for the proposal that spatially specific white matter damage affecting bottleneck regions, particularly in the posterior temporal lobe, contributes to chronic language deficits after left hemispheric stroke. This may reflect the simultaneous disruption of signaling in dorsal and ventral language processing streams.
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One explanation for the constraint is that white matter can act as a bottleneck for multiple processing tracts from multiple neural networks, all of which are affected when the bottleneck is damaged, thereby limiting resources for recovery.
“One explanation for this is that white matter can act as a bottle neck for multiple processing tracts from multiple neural networks, all of which are affected when the bottle neck is damaged, thereby limiting resources for recovery (Griffis et al., 2017).”
From Damage to Broca’s area does not contribute to long-term speech production outcome after stroke (2021) · cites this paper as Griffis et al., 2017
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Advanced lesion symptom mapping analyses and implementation as BCBtoolkit
Foulon, C., Cerliani, L., Kinkingnéhun, S., Lévy, R., Rosso, C., Urbanski, M., Emmanuelle Volle, C., & de Schotten, M. T. (2018) · GigaScience · doi:10.1093/gigascience/giy004 · Cited by 359 · see citing works
Structural disconnections explain brain network dysfunction after stroke
Griffis, J. C., Metcalf, N. V., Corbetta, M., & Shulman, G. L. (2019) · Cell Reports · doi:10.1016/j.celrep.2019.07.100 · Cited by 213 · see citing works
Self-citationZhao, L., Biesbroek, J. M., Shi, L., Liu, W., Kuijf, H. J., Chu, C. W., Abrigo, J., Lee, R. K. L., Leung, T. W. H., Lau, A. Y. L., et al. (2017) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x17728162 · Cited by 208 · see citing works
Improved accuracy of lesion to symptom mapping with multivariate sparse canonical correlations
Pustina, D., Avants, B., Faseyitan, O. K., Medaglia, J. D., & Coslett, H. B. (2017) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2017.08.027 · Cited by 183 · see citing works
Damage to Broca’s area does not contribute to long-term speech production outcome after stroke
Gajardo-Vidal, A., Lorca-Puls, D. L., team, P., Warner, H., Pshdary, B., Crinion, J. T., Leff, A. P., Hope, T. M. H., Geva, S., Seghier, M. L., et al. (2021) · Brain · doi:10.1093/brain/awaa460 · Cited by 150 · see citing works
Griffis, J. C., Metcalf, N. V., Corbetta, M., & Shulman, G. L. (2021) · NeuroImage Clinical · doi:10.1016/j.nicl.2021.102639 · Cited by 140 · see citing works
Functional Contributions of the Arcuate Fasciculus to Language Processing
Ivanova, M. V., Zhong, A. J., Turken, A. U., Baldo, J. V., & Dronkers, N. F. (2021) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2021.672665 · Cited by 108 · see citing works
Post-stroke outcomes predicted from multivariate lesion-behaviour and lesion network mapping
Bowren, M. D., Bruss, J., Manzel, K. W., Edwards, D. J., Liu, C. Y., Corbetta, M., Tranel, D., & Boes, A. D. (2022) · Brain · doi:10.1093/brain/awac010 · Cited by 110 · see citing works
Ivanova, M. V., Herron, T. J., Dronkers, N. F., & Baldo, J. V. (2020) · Human Brain Mapping · doi:10.1002/hbm.25278 · Cited by 79 · see citing works
An empirical evaluation of multivariate lesion behaviour mapping using support vector regression
Sperber, C., Wiesen, D., & Karnath, H. (2018) · Human Brain Mapping · doi:10.1002/hbm.24476 · Cited by 74 · see citing works
Griffis, J. C., Metcalf, N. V., Corbetta, M., & Shulman, G. L. (2020) · NeuroImage · doi:10.1016/j.neuroimage.2020.116589 · Cited by 72 · see citing works
Reber, J., Hwang, K., Bowren, M. D., Bruss, J., Mukherjee, P., Tranel, D., & Boes, A. D. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2018784118 · Cited by 73 · see citing works
Uncovering the Neuroanatomy of Core Language Systems Using Lesion-Symptom Mapping
Mirman, D., & Thye, M. D. (2018) · Current Directions in Psychological Science · doi:10.1177/0963721418787486 · Cited by 61 · see citing works
Shekari, E., & Nozari, N. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1139292 · Cited by 67 · see citing works
Meier, E. L., Johnson, J. P., Pan, Y., & Kiran, S. (2019) · Brain Imaging and Behavior · doi:10.1007/s11682-019-00118-3 · Cited by 53 · see citing works
Zekelman, L., Zhang, F., Makris, N., He, J., Chen, Y., Xue, T., Liera, D., Drane, D. L., Yogesh Rathi, A., Golby, A. J., et al. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2021.118739 · Cited by 50 · see citing works
Roles of ventral versus dorsal pathways in language production: An awake language mapping study
Riès, S., Piai, V., Perry, D. W., Griffin, S., Jordan, K., Henry, R. G., Knight, R. T., & Berger, M. S. (2019) · Brain and Language · doi:10.1016/j.bandl.2019.01.001 · Cited by 49 · see citing works
Fluency and rule breaking behaviour in the frontal cortex
Lisa Cipolotti, A., Molenberghs, P., Domínguez, J. F., Smith, N., Smirni, D., Xu, T., Shallice, T., & Chan, E. (2019) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2019.107308 · Cited by 48 · see citing works
Network-behavior mapping of lasting executive impairments after low-grade glioma surgery
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Wiesen, D., Sperber, C., Yourganov, G., Rorden, C., & Karnath, H. (2019) · NeuroImage · doi:10.1016/j.neuroimage.2019.07.013 · Cited by 45 · see citing works
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Multivariate Lesion-Behavior Mapping of General Cognitive Ability and Its Psychometric Constituents
Bowren, M. D., Adolphs, R., Bruss, J., Manzel, K. W., Corbetta, M., Tranel, D., & Boes, A. D. (2020) · Journal of Neuroscience · doi:10.1523/jneurosci.1415-20.2020 · Cited by 37 · see citing works
Longitudinal fMRI study of language recovery after a left hemispheric ischemic stroke
Nenert, R. E., Allendorfer, J. B., Martin, A. M., Banks, C., Vannest, J. J., Holland, S. K., Hart, K. W., Lindsell, C. J., & Szaflarski, J. P. (2018) · Restorative Neurology and Neuroscience · doi:10.3233/rnn-170767 · Cited by 39 · see citing works
Mapping articulatory and grammatical subcomponents of fluency deficits in post-stroke aphasia
Mirman, D., Kraft, A. E., Harvey, D. Y., Brecher, A. R., & Schwartz, M. F. (2019) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-019-00729-9 · Cited by 37 · see citing works
Lesion network mapping: where do we go from here?
Boes, A. D. (2020) · Brain · doi:10.1093/brain/awaa350 · Cited by 36 · see citing works
Billot, A., de Schotten, M. T., Parrish, T. B., Thompson, C. K., Rapp, B. C., Caplan, D. N., & Kiran, S. (2022) · Cortex · doi:10.1016/j.cortex.2022.06.016 · Cited by 33 · see citing works
Szaflarski, J. P., Nenert, R. E., Allendorfer, J. B., Martin, A. N., Amara, A. W., Griffis, J. C., Dietz, A. R., Mark, V. W., Sung, V., Walker, H. C., et al. (2021) · Medical Science Monitor · doi:10.12659/msm.931468 · Cited by 34 · see citing works
The unique role of the frontal aslant tract in speech and language processing
Zhong, A. J., Baldo, J. V., Dronkers, N. F., & Ivanova, M. V. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103020 · Cited by 32 · see citing works
Griffis, J. C., Nenert, R. E., Allendorfer, J. B., & Szaflarski, J. P. (2017) · Cortex · doi:10.1016/j.cortex.2017.08.031 · Cited by 33 · see citing works
Meier, E. L., Johnson, J. P., & Kiran, S. (2018) · Cortex · doi:10.1016/j.cortex.2018.08.006 · Cited by 32 · see citing works
A Review on Treatment-Related Brain Changes in Aphasia
Schevenels, K., Price, C. J., Zink, I., Smedt, B. D., & Vandermosten, M. (2020) · Neurobiology of Language · doi:10.1162/nol_a_00019 · Cited by 32 · see citing works
Camerino, I., Sierpowska, J., Reid, A., Meyer, N. H., Tuladhar, A. M., Kessels, R. P. C., de Leeuw, F., & Piai, V. (2020) · Human Brain Mapping · doi:10.1002/hbm.25273 · Cited by 32 · see citing works
Piai, V., & Eikelboom, D. (2023) · Neurobiology of Language · doi:10.1162/nol_a_00097 · Cited by 31 · see citing works
Sperber, C., Wiesen, D., Goldenberg, G., & Karnath, H. (2019) · Cortex · doi:10.1016/j.cortex.2019.08.023 · Cited by 31 · see citing works
The emergence of multiscale connectomics-based approaches in stroke recovery
Latifi, S., & Carmichael, S. T. (2024) · Trends in Neurosciences · doi:10.1016/j.tins.2024.01.003 · Cited by 28 · see citing works
Wiesen, D., Karnath, H., & Sperber, C. (2020) · Cortex · doi:10.1016/j.cortex.2020.09.012 · Cited by 28 · see citing works
Prediction of Aphasia Severity in Patients with Stroke Using Diffusion Tensor Imaging
Lee, J.-K., Ko, M.-H., Park, S.-H., & Kim, G.-W. (2021) · Brain Sciences · doi:10.3390/brainsci11030304 · Cited by 26 · see citing works
The entire brain, more or less, is at work : 'Language regions' are artefacts of averagingPreprint
Aliko, S., Franch, M., Kewenig, V. N., Wang, B., Cooper, G. J., Glotfelty, A., Hayden, B. Y., Small, S. L., & Skipper, J. I. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.09.01.555886 · Cited by 29 · see citing works
Halai, A. D., Woollams, A. M., & Ralph, M. A. L. (2018) · NeuroImage Clinical · doi:10.1016/j.nicl.2018.03.011 · Cited by 24 · see citing works
Geller, J., Thye, M. D., & Mirman, D. (2019) · NeuroImage · doi:10.1016/j.neuroimage.2019.01.020 · Cited by 25 · see citing works
The white matter architecture underlying semantic processing: A systematic review
Cocquyt, E., Lanckmans, E., van Mierlo, P., Duyck, W., Szmalec, A., Santens, P., & Letter, M. D. (2019) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2019.107182 · Cited by 23 · see citing works
Dissociable contributions of frontal and temporal brain regions to basic semantic composition
Graessner, A., Zaccarella, E., Friederici, A. D., Obrig, H., & Hartwigsen, G. (2021) · Brain Communications · doi:10.1093/braincomms/fcab090 · Cited by 21 · see citing works
Joint impact on attention, alertness and inhibition of lesions at a frontal white matter crossroad
Kaufmann, B. C., Cazzoli, D., Pastore‐Wapp, M., Vanbellingen, T., Pflugshaupt, T., Bauer, D., Müri, R. M., Nef, T., Bartolomeo, P., & Nyffeler, T. (2022) · Brain · doi:10.1093/brain/awac359 · Cited by 19 · see citing works
A general role for ventral white matter pathways in morphological processing: Going beyond reading
Yablonski, M., Menashe, B. A., & Ben‐Shachar, M. (2020) · NeuroImage · doi:10.1016/j.neuroimage.2020.117577 · Cited by 16 · see citing works
Röhrig, L., Sperber, C., Bonilha, L., Rorden, C., & Karnath, H. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103265 · Cited by 16 · see citing works
Language Neuroplasticity in Brain Tumor Patients Revealed by Magnetoencephalography
Piai, V., Witte, E. D., Sierpowska, J., Zheng, X., Hinkley, L. B. N., Mizuiri, D., Knight, R. T., Berger, M. S., & Nagarajan, S. S. (2020) · Journal of Cognitive Neuroscience · doi:10.1162/jocn_a_01561 · Cited by 16 · see citing works
Meier, E. L., Sheppard, S. M., Goldberg, E. B., Head, C. R., Ubellacker, D. M., Walker, A., & Hillis, A. E. (2020) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2020.107651 · Cited by 17 · see citing works
Independent contributions of structural and functional connectivity: Evidence from a stroke model
Keator, L. M., Yourganov, G., Basilakos, A., Hillis, A. E., Hickok, G. S., Bonilha, L., Rorden, C., & Fridriksson, J. (2021) · Network Neuroscience · doi:10.1162/netn_a_00207 · Cited by 13 · see citing works
Four dimensions of naturalistic language production in aphasia after stroke
Casilio, M., Kasdan, A. V., Bryan, K. M., Shibata, K., Schneck, S. M., Levy, D. F., Entrup, J. L., Onuscheck, C. F., de Riesthal, M. R., & Wilson, S. M. (2024) · Brain · doi:10.1093/brain/awae195 · Cited by 12 · see citing works
Multivariate machine learning‐based language mapping in glioma patients based on lesion topography
Zhang, N., Yuan, B., Yan, J., Cheng, J., Lu, J., & Wu, J. (2021) · Brain Imaging and Behavior · doi:10.1007/s11682-021-00457-0 · Cited by 12 · see citing works
Suárez-Meade, P., Marenco-Hillembrand, L., Sabsevitz, D. S., Okromelidze, L., Perdikis, B., Sherman, W. J., Quiñones‐Hinojosa, A., Middlebrooks, E. H., & Chaichana, K. L. (2022) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2022.107512 · Cited by 12 · see citing works
Garcea, F. E., & Buxbaum, L. J. (2022) · Cortex · doi:10.1016/j.cortex.2023.06.012 · Cited by 11 · see citing works
Multivariate lesion symptom mapping for predicting trajectories of recovery from aphasia
Levy, D. F., Entrup, J. L., Schneck, S. M., Onuscheck, C. F., Rahman, M., Kasdan, A. V., Casilio, M., Willey, E., Davis, L. T., de Riesthal, M. R., et al. (2023) · Brain Communications · doi:10.1093/braincomms/fcae024 · Cited by 13 · see citing works
Griffis, J. C., Bruss, J., Acker, S. F., Shea, C., Tranel, D., & Boes, A. D. (2024) · Human Brain Mapping · doi:10.1002/hbm.70115 · Cited by 11 · see citing works
Perioperative Neurocognitive Function in Glioma Surgery
Noll, K. R., Bradshaw, M. E., Sheppard, D. P., & Wefel, J. S. (2024) · Current Oncology Reports · doi:10.1007/s11912-024-01522-9 · Cited by 10 · see citing works
Lewis, L., Corcoran, M., Cho, K. I. K., Kwak, Y., Hayes, R. A., Larsen, B., & Jalbrzikowski, M. (2023) · Schizophrenia · doi:10.1038/s41537-023-00411-7 · Cited by 9 · see citing works
León-Cabrera, P., Pagonabarraga, J., Morís, J., Martínez‐Horta, S., Marín‐Lahoz, J., Horta‐Barba, A., Bejr‐Kasem, H., Kulisevsky, J., & Rodríguez‐Fornells, A. (2021) · Cortex · doi:10.1016/j.cortex.2021.03.032 · Cited by 9 · see citing works
Chupina, I., Sierpowska, J., Zheng, X., Dewenter, A., Piastra, M. C., & Piai, V. (2022) · European Journal of Neuroscience · doi:10.1111/ejn.15813 · Cited by 8 · see citing works
Selecting and Analyzing Speech Features for the Screening of Mild Cognitive Impairment
Yang, Q., Xu, F., Ling, Z.-H., Li, X., Li, Y., & Fang, D. (2021) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc46164.2021.9630752 · Cited by 8 · see citing works
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Low, T. A., Chilvers, M. J., Zhu, H., Carlson, H. L., Harris, A. D., Goodyear, B. G., & Dukelow, S. P. (2024) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2024.123065 · Cited by 5 · see citing works
The effect of venlafaxine on language function in patients with subcortical aphasia
Wang, L., Li, C., Liu, L., Zhang, W., & Liu, Y. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.04.015 · Cited by 4 · see citing works
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Brzus, M., Griffis, J. C., Riley, C. J., Bruss, J., Shea, C., Johnson, H. J., & Boes, A. D. (2026) · npj Digital Medicine · doi:10.1038/s41746-026-02803-2 · Cited by 4 · see citing works
Preoperative Brain Mapping Predicts Language Outcomes After Eloquent Tumor Resection
Muir, M. T., Noll, K. R., Prinsloo, S., Michener, H., Traylor, J. I., Kumar, V. A., Ene, C., Ferguson, S. D., Liu, H., Weinberg, J. S., et al. (2025) · Human Brain Mapping · doi:10.1002/hbm.70340 · Cited by 3 · see citing works
Preserved anatomical bypasses predict variance in language functions after stroke
Erickson, B. A., Kim, B., Deck, B. L., Pustina, D., DeMarco, A. T., Dickens, J. V., Kelkar, A. S., Turkeltaub, P. E., & Medaglia, J. D. (2022) · Cortex · doi:10.1016/j.cortex.2022.05.023 · Cited by 3 · see citing works
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Language neuroplasticity in brain tumour patients revealed by magnetoencephalographyPreprint
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Glass Half Full: Preserved Anatomical Bypasses Predict Variance in Language Functions After StrokePreprint
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Age-associated alterations in thalamocortical structural connectivity in psychosis-spectrum youthsPreprint
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A case report of crossed aphasia, grasping, and intermanual conflict with the left hand
Sakamoto, F., Kodani, Y., Nakamura, K., & Fukunaga, S. (2026) · Neurocase · doi:10.1080/13554794.2026.2676581
The interacting language network: A framework for neuromodulation and clinical translation
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- Authors
- Griffis, J. C., Nenert, R., Allendorfer, J. B., & Szaflarski, J. P.
- Affiliations
- University of Alabama at Birmingham (US)
- Corresponding author
- Griffis, Joseph C.
- Venue
- NeuroImage Clinical
- Publisher
- Elsevier BV
- Published
- 2017
- Volume
- 14
- Pages
- 552-565
- ISSN
- 2213-1582 (ISSN-L)
- PMC
- PMC5350568
- OpenAlex
- W2519305849
- Cited by
- 87
- References
- 97
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 12 · 2021: 13 · 2020: 15 · 2019: 12 · 2018: 8 · 2017: 4
- FWCI
- 6.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- NeuroImage Clinical (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- arXiv (Cornell University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- arXiv (Cornell University)
- Funders
- National Institutes of Health (NIH R01 HD068488, NIH R01 NS048281)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hemispheric Asymmetry in Neuroscience
- Keywords
- left hemispheric stroke, language deficits, posterior temporal lobe, semantic deficits, verbal fluency, picture naming, thalamocortical connections, lesion-symptom mapping, tractography, chronic stroke
- MeSH terms
- Adult, Aged, Brain Mapping, Decision Making, Female, Humans, Image Processing, Computer-Assisted, Language Disorders, Language Tests, Functional Laterality, Magnetic Resonance Imaging, Male, Middle Aged, Regression Analysis, Semantics, Verbal Behavior, Stroke, White Matter
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