Left Thalamic Hemorrhage Research Articles

Aphasia Does Not Always Follow Left Thalamic Hemorrhage: A Study of Five Negative Cases

Five right-handed patients suffering from a recent CT-assessed left posterior thalamic hemorrhage are reported. In all patients a standard language examination performed -within one month after stroke onset did not reveal aphasic disturbances. While the present series argues for the role of mtrathalamic lesion localization, a review of the literature suggests that lesion site per se does not always account for the presence or absence of aphasia in the individual case. The importance of reduced blood flow and metabolism in cortical areas which appear undamaged on CT scan is briefly discussed.

Syndrome of Semantic Aphasia Caused by Bilateral Thalamic Lesions

A case is reported of a 60' year- old right-handed man in whom syndrome of semantic aphasia developed 5 months after the onset of a left thalamic hemorrhage preceded by a right thalamic hemorrhage which has occured about 21 months before. He was admitted to Kuwana Hospital because of vomiting and left hemiparesis on April 23, 1983. CT scanning disclosed a hematoma measuring about 11 ml which occupied the postero-lateral portion of the right thalamus rupturing into the trigon of the lateral ventricle. Left spatial agnosia, construetional disturbance and left homonymous hemianopia were found. He showed improvement and was discharged about 1 month after the admission. On July 18, 1985, he was admitted again because of the occurrence of a hematoma measuring about 4 ml which involved the postero-lateral portion of the left thalamus extending medially and upwards. Examinations revealed transcortical sensory aphasia as well as left spatial agnosia and constructional disturbance which had been found during the first admission. About 5 months after the admission, the transcortical sensory aphasia disappeared and a syndrome of semantic aphasia developed associated with simultaneus agnosia. Four months later, the syndrome of semantic aphasia improved greatly and the other syndrome showed some improvement. Our case with semantic aphasia had all the components of typical semantic aphasia described by Ohashi et al and was similar to cases with semantic aphasia caused by cortical lesion reported by Hier. This semantic aphasia lasted for a relatively long period was considered to be due to the bilateral thalamic lesions.

Mirror Writing with Left Thalamic Hemorrhage

Three cases of mirror writing ( MW) with left thalamic hemorrhage were reported. All were right handed and the MW was limited to the left hand. All showed slight deficit in short term memory and in calculation. But none showed constructional difficulty or unilateral spatial neglect. Only one of them was considered as aphasic. MW was seen in voluntary writing and on dictation. Eye closure facilitated the tendency for MW. Also, it became more prominent when they had to write laterally from right to left than from left to right or in vertical direction. Automatic writing also facilitated the tendency while attention tended to suppress it. This tendency for MW seemed to fluctuate according to the level level of attention. As for the mechanism of MW in three cases, we discussed a possible role of the left thalamus. MW in the left hand can be seen in normal person under certain conditions. Therefore the MW seen in these cases may simply be a disclosure of the normal latent tendency. Lesions in the left thalamus may have contributed to the appearance of the MW by disturbing the attentional mechanism.

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

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.

Aphasia-like disorders following left thalamic hemorrhage

Disorders of speech and other mentalfunctions in eight patients with left thalamic hematoma were examined, both in their acute and chronic stage. The examinations in the acuts stage revealed a decrease of vigilance in 7 cases, fatiguability in 6 cases, a paucity of spontaneous speech in 6 cases and small vocal volume in 5 cases. In addition, 6 out of cases exhibited some speech disorders, inluding paraphasia, word-finding difficulties, circumlocution. The other two cases showed memory dis turbance and / or disorientation. Fluency, repetition and comprehension were well preserved in all cases. And, in the chronic stage, disor ders of speech and other mental functions almos disappeared in 7 cases out of the 8. Those defects were not considered as being aphasia, but as a lack of activation of higher mental functions in the dominant hemisphere.

“Transcortical” Features of Aphasia Following Left Thalamic Hemorrhage

In a series of 14 thalamic hemorrhage documented by Computerized Axial Tomography (CT) scans, aphasia was present in seven out of eight patients with left lesions while it was absent in the six patients with right lesions. In three cases where detailed language testing was performed, aphasia was characterized by reduction of spontaneous speech with semantic paraphasias, preserved repetition and partially defective auditory verbal comprehension. The language disturbance was persistent in two patients, while it recovered spontaneously within four weeks in one patient. The clinical picture in these patients is similar to the classical "transcortical" aphasias, which are usually due to damage of the marginal language areas. It is suggested that the left thalamus contributes to the semantic level of verbal behavior, which is possibly subserved by these areas.

Reversibility of Parinaud syndrome in thalamic hemorrhage

Parinaud syndrome, associated with a left thalamic hemorrhage, disappeared completely in a 57-year-old woman after ventriculoperitoneal shunt. The syndrome may be attributed to increased intracranial pressure owing to mass effect on the pretectal region and tectum, or to tightness in the incisura causing hydrocephalus secondary to aqueduct compression. The lesions responsible for the syndrome may not be irreversible.

Left thalamic hemorrhage with dysphasia: A report of five cases

A specific type of “thalamic speech” is being recognized with increasing frequency. Paucity of spontaneous speech, fading vocal volume, anomia, perseveration, and neologisms, with intact comprehension and word repetition, characterize the speech disorder associated with thalamic lesions. Nine cases of left thalamic hemorrhage and speech disturbance have been reported previously. This report details the speech, neurological, and neuroradiological findings in five additional cases of thalamic hemorrhage with dysphasia.

Thalamic hemorrhage and aphasia

The behavioral effects of left thalamic hemorrhage are reported in two living cases, reviewed in four autopsied cases derived from a 15 year retrospective review of 16,000 autopsies, and compared with autopsied cases reported in the literature. An unusual fluctuating state is described. When rendered fully alert, the patients appeared virtually intact in language function, including intact repeating from dictation, but quickly lapsed into a state of unwonted logorrheic paraphasia resembling delirium. The state appeared sufficiently unusual to warrant description as an entity separate from traditional aphasic syndromes.

Localized thalamic hemorrhage. A cause of aphasia.

SUMMARYTwo pathologically proved cases of left thalamic hemorrhage producing mixed aphasia are presented. The anatomical and pathogenetic mechanisms are discussed.