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Cortex. 2016 Apr;77:95-118. doi: 10.1016/j.cortex.2016.01.010. Epub 2016 Feb 4.

Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Author information

1
Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Basic Psychology, University of Barcelona, Barcelona, Spain.
2
Department of Basic Psychology, University of Barcelona, Barcelona, Spain; Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona, Barcelona, Spain.
3
Department of Neonatology, Hospital Sant Joan de Déu, Barcelona, Spain.
4
Department of Pediatric Neurology, Hospital Sant Joan de Déu, Barcelona, Spain.
5
Department of Basic Psychology, University of Barcelona, Barcelona, Spain.
6
Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Basic Psychology, University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain. Electronic address: antoni.rodriguez@icrea.cat.

Abstract

Brain imaging methods have contributed to shed light on the possible mechanisms of recovery and cortical reorganization after early brain insult. The idea that a functional left hemisphere is crucial for achieving a normalized pattern of language development after left perinatal stroke is still under debate. We report the case of a 3.5-year-old boy born at term with a perinatal ischemic stroke of the left middle cerebral artery, affecting mainly the supramarginal gyrus, superior parietal and insular cortex extending to the precentral and postcentral gyri. Neurocognitive development was assessed at 25 and 42 months of age. Language outcomes were more extensively evaluated at the latter age with measures on receptive vocabulary, phonological whole-word production and linguistic complexity in spontaneous speech. Word learning abilities were assessed using a fast-mapping task to assess immediate and delayed recall of newly mapped words. Functional and structural imaging data as well as a measure of intrinsic connectivity were also acquired. While cognitive, motor and language levels from the Bayley Scales fell within the average range at 25 months, language scores were below at 42 months. Receptive vocabulary fell within normal limits but whole word production was delayed and the child had limited spontaneous speech. Critically, the child showed clear difficulties in both the immediate and delayed recall of the novel words, significantly differing from an age-matched control group. Neuroimaging data revealed spared classical cortical language areas but an affected left dorsal white-matter pathway together with right lateralized functional activations. In the framework of the model for Social Communication and Language Development, these data confirm the important role of the left arcuate fasciculus in understanding and producing morpho-syntactic elements in sentences beyond two word combinations and, most importantly, in learning novel word-referent associations, a building block of language acquisition.

KEYWORDS:

Arcuate fasciculus; Language development; Left perinatal stroke; Neuroimaging; Word learning

PMID:
26922507
DOI:
10.1016/j.cortex.2016.01.010
[Indexed for MEDLINE]

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