Atypical language organization following perinatal infarctions of the left hemisphere is associated with structural changes in right‐hemispheric grey matter.

Aim: To assess how atypical language organization after early left‐hemispheric brain lesions affects grey matter in the contralesional hemisphere. Method: This was a cross‐sectional study with between‐group comparisons of 14 patients (six female, 8–26 years) with perinatal left‐hemispheric brain lesions (two arterial ischemic strokes, 11 periventricular haemorrhagic infarctions, one without classification) and 14 typically developing age‐matched controls (TDC) with functional magnetic resonance imaging (fMRI) documented left‐hemispheric language organization (six female, 8–28 years). MRI data were analysed with SPM12, CAT12, and custom scripts. Language lateralization indices were determined by fMRI within a prefrontal mask and right‐hemispheric grey matter group differences by voxel‐based morphometry (VBM). Results: FMRI revealed left‐dominance in seven patients with typical language organization (TYP) and right‐dominance in seven patients with atypical language organization (ATYP) of 14 patients. VBM analysis of all patients versus controls showed grey matter reductions in the middle temporal gyrus of patients. A comparison between the two patient subgroups revealed an increase of grey matter in the middle frontal gyrus in the ATYP group. Voxel‐based regression analysis confirmed that grey matter increases in the middle frontal gyrus were correlated with atypical language organization. Interpretation: Compatible with a non‐specific lesion effect, we found areas of grey matter reduction in patients as compared to TDC. The grey matter increase in the middle frontal gyrus seems to reflect a specific compensatory effect in patients with atypical language organization. What this paper adds: Perinatal stroke leads to decreased grey matter in the contralesional hemisphere.Atypical language organization is associated with grey matter increases in contralesional language areas. [ABSTRACT FROM AUTHOR]