The Disruption and Normalization of Cortical Language Network Dynamics After Post-Stroke White Matter Disconnection

The human language network undergoes reorganization across different spatiotemporal scales, limited by its fixed structural neurobiological foundations. Although stroke often damages white matter, its effect on temporary language network reorganization is not fully understood. This study examined longitudinal behavioral and resting-state fMRI data from post-stroke patients with exclusive subcortical lesions at three time points: two weeks (n = 38), three months (n = 29), and one year (n = 27). Patients showed mild to moderate language impairments during the acute phase, which improved within three months. The extent of disconnection in several left-hemispheric white matter tracts was negatively associated with language deficits. Healthy controls (HC, n = 25) exhibited domain-segregation dynamics in the cortical language network, limited by the underlying white matter pathways. In patients, severe, state- and track-specific network disruptions were observed in the acute phase, characterized by hypo- and hyper-connectivity and abnormal topological features. As language recovery progressed, connectivity patterns began to return to normal, resembling those of HC, and the domain-segregation dynamics reappeared. These results deepen our understanding of structure-function coupling and indicate significant post-lesional plasticity within the cortical language network.