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Damage to the white matter underlying the left posterior temporal lobe leadsto deficits in multiple language functions. The posterior temporal white mattermay correspond to a bottleneck where both dorsal and ventral language pathwaysare vulnerable to simultaneous damage. Damage to a second putative white matterbottleneck in the left deep prefrontal white matter involving projectionsassociated with ventral language pathways and thalamo-cortical projections hasrecently been proposed as a source of semantic deficits after stroke. However,the effects of damage to a priori identified white matter bottlenecks onlanguage function have not been directly investigated. Here, we first usedwhite matter atlases to identify the previously described white matterbottlenecks in the posterior temporal and deep prefrontal white matter. We thenassessed the effects of damage to each region on measures of category fluency,picture naming, and auditory semantic decision-making in 43 patients withchronic aphasia. Damage to the posterior temporal bottleneck predicted deficitson all language measures, while damage to the anterior bottleneck onlypredicted deficits in category fluency. Importantly, the effects of damage tothe bottleneck regions were not attributable to lesion volume, lesion loads onthe tracts traversing the bottlenecks, or damage to nearby cortical languageareas. Multivariate lesion-symptom mapping and fiber tracking analysescorroborated these findings. Together, our results provide strong support forthe proposal that spatially specific white matter damage affecting white matterbottlenecks, particularly in the posterior temporal lobe, contribute to chroniclanguage deficits after left hemispheric stroke. Our results suggest thatdamage to this area is likely to simultaneously disrupt signaling via thesimultaneous disruption of dorsal and ventral language processing streams.

Damage to white matter bottlenecks contributes to language impairments after left hemispheric stroke