Aphasia Caused by Left Thaiamic Hemorrhage. Report of An Autopsy Case.

Abstract

An autopsy case of a 56-year-old right-handed male with mixed dysphasia due to left thalamic hemorrhage was reported. is clinical symptoms began with weakness of the right leg and consciousness disturbance. He was admitted immediately to Kuwana hospital. On admission he was in a drowsy state with right hemiparesis, dysarthria and naming disorders. A CT scan revealed a hematoma ( 16 × 18 × 25 mm in diameter) in the left thalamus. On the 6th hospital day he had become alert, SLTA showed distinctive features of mixed dysphasia with severe acalculia. With improvement of the right hemiparesis and dysarthria, the symptoms of mixed dysphasia gradually faded away and became almost undiscernible on the 27th hospital day. However, acalculia and disorders of constructive praxis persisted. Perforation of gastric ulcer and subsequent sepsis resulted in death on the 64th hospital day. Postmortem examination of the brain showed a small hematoma ( 12 × 12 × l5 mm in diameter ) in the thalamus and posterior limb of the internal capsule on the left side. The localization of the hematoma was investigated, according to Schaltenbrand's atlas. The hematoma involved the thalamic nuclei of D. im. e., D. im. i., Z. im. e., Z. im. i., Ce., V. im. e., V. im. i., V. c. e., V. c. i., V. c. par., V. c. pc. and V. c. por.. The aphasic symptoms were transient and discernible only in the acute period. This suggests that the aphasic symptoms were caused by the hematoma itself and its accompanying effects in the acute period such as compression and edema on the pulvinar and other adjacent structures which have thalamo-cortical association fibers.