Disturbances of semantic and phonemic fluency are common after brain damage, as a manifestation of language, executive, or memory dysfunction. Lesion-symptom mapping (LSM) studies can provide fundamental insights in shared and distinct anatomical correlates of these cognitive functions and help to understand which patients suffer from these deficits. We performed a multivariate support vector regression-based lesion-symptom mapping and structural disconnection study on semantic and phonemic fluency in 1231 patients with acute ischemic stroke. With the largest-ever LSM study on verbal fluency we achieved almost complete brain lesion coverage. Lower performance on both fluency types was related to left hemispheric frontotemporal and parietal cortical regions, and subcortical regions centering on the left thalamus. Distinct correlates for phonemic fluency were the anterior divisions of middle and inferior frontal gyri. Distinct correlates for semantic fluency were the posterior regions of the middle and inferior temporal gyri, parahippocampal and fusiform gyri and triangular part of the inferior frontal gyrus. The disconnectome-based analyses additionally revealed phonemic fluency was associated with a more extensive frontoparietal white matter network, whereas semantic fluency was associated with disconnection of the fornix, mesiotemporal white matter, splenium of the corpus callosum. These results provide the most detailed outline of the anatomical correlates of phonemic and semantic fluency to date, stress the crucial role of subcortical regions and reveal a novel dissociation in the left temporal lobe.

脑损伤后，语义和音素流畅性的障碍很常见，这是语言、执行或记忆功能障碍的表现。病变症状映射 (LSM) 研究可以提供对这些认知功能的共享和不同解剖关联的基本见解，并有助于了解哪些患者患有这些缺陷。我们对 1231 名急性缺血性卒中患者的语义和音素流畅性进行了基于多变量支持向量回归的病变症状映射和结构断开研究。通过有史以来最大规模的 LSM 语言流畅性研究，我们几乎完全覆盖了脑部病变。两种流畅类型的较低表现与左半球额颞叶和顶叶皮层区域以及以左丘脑为中心的皮层下区域有关。音素流畅性的不同相关性是额中回和下回的前部。语义流畅性的不同相关性是颞中回和下回的后部区域、海马旁回和梭状回以及额下回的三角形部分。基于断开组的分析还显示，音素流畅性与更广泛的额顶白质网络相关，而语义流畅性与穹窿、中颞白质、胼胝体压部的断开相关。这些结果提供了迄今为止音素和语义流畅性的解剖关联的最详细轮廓，强调了皮层下区域的关键作用，并揭示了左颞叶的一种新的分离。