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December 1984, Vol 41, No. 12 >
Article | December 1984

Aphasia After Left Thalamic Infarction

Philip B. Gorelick, MD; Daniel B. Hier, MD; Louis Benevento, PhD; Susan Levitt, MS; Walter Tan, MD
[+] Author Affiliations

Accepted for publication Dec 15, 1983.

Reprint requests to Cerebrovascular Service, Department of Neurology, University of Illinois College of Medicine, Chicago, IL 60612 (Dr Gorelick).


Arch Neurol. 1984;41(12):1296-1298. doi:10.1001/archneur.1984.04050230082026
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• We examined a 70-year-old woman who became aphasic after a left thalamic infarction. Computed tomographic scan showed injury that was largely limited to the ventral anterior and rostral ventral lateral thalamic nuclei. Speech was characterized by reduced voice volume, impaired auditory and reading comprehension, perseverations, intermittent use of jargon, fluctuations in the ability to perform confrontation naming, extraneous intrusions, verbal paraphasia, intact repetition skills, and fluent speech that was laconic but grammatically correct. We propose that the deficits after left thalamic injury can be grouped into the following four large clusters: extrapyramidal deficits (decreased or fading voice volume), deficits in lexical access (anomia, verbal paraphasia), deficits in vigilance (neologisms, intrusions, fluctuating performance, jargon, perseverations), and comprehension defects.

REFERENCES

1 +
Demeurisse G, Derouck M, Coekaerts M-J, et al:  A study of two cases of aphasia by infarction of the left thalamus, without cortical lesion . Acta Neurol Belg 1979;;79:450-459.
2 +
Cohen JA, Gelfer CE, Sweet RD:  Thalamic infarction producing aphasia . Mt Sinai J Med 1980;;47:389-404.
3 +
McFarling D, Rothi LJ, Heilman KM:  Transcortical aphasia from ischemic infarcts of the thalamus: A report of two cases . J Neurol Neurosurg Psychiatry 1982;;45:107-112.
4 +
Graff-Radford NR, Eslinger PJ, Damasio AR, et al:  Nonhemorrhagic infarction of the thalamus: Behavioral, anatomical and physiological correlates . Neurology 1983;;33( (suppl 2) ):164.
5 +
Fisher CM:  The pathologic and clinical aspects of thalamic hemorrhage . Trans Am Neurol Assoc 1959;;84:56-59.
6 +
Ciemins VA:  Localized thalamic hemorrhage: A cause of aphasia . Neurology 1970;; 20:776-782.
7 +
Mohr JP, Watters WC, Duncan GW:  Thalamic hemorrhage and aphasia . Brain Lang 1975;; 2:3-17.
8 +
Walshe TM, Davis KR, Fisher CM:  Thalamic hemorrhage: A computed tomographic-clinical correlation . Neurology 1977;;27:217-222.
9 +
Reynolds AF, Harris AB, Ojemann GA, et al:  Aphasia and left thalamic hemorrhage . J Neurosurg 1978;;48:570-574.
10 +
Reynolds AF, Turner PT, Harris AB, et al:  Left thalamic hemorrhage with dysphasia: A report of five cases . Brain Lang 1979;;7:62-73.
11 +
Cappa SF, Vignolo LA: ' Transcortical' features of aphasia following left thalamic hemorrhage . Cortex 1979;;15:121-130.
12 +
Alexander MP, LoVerme SR:  Aphasia after left thalamic intracerebral hemorrhage . Neurology 1980;;30:1193-1202.
13 +
Kirshner HS, Kistler KH:  Aphasia after right thalamic hemorrhage . Arch Neurol 1982;; 39:667-669.
14 +
Chesson AL:  Aphasia following a right thalamic hemorrhage . Brain Lang 1983;;19:306-316.
15 +
Smyth GE, Stern K:  Tumours of the thalamus: A clinico-pathological study . Brain 1938;; 61:339-374.
16 +
McKissock W, Paine KWE:  Primary tumours of the thalamus . Brain 1958;;81:41-63.
17 +
Cheek WR, Taveras JM:  Thalamic tumors . J Neurosurg 1966;;24:505-513.
18 +
Boetz MI, Barbeau A:  Role of subcortical structures, and particularly of the thalamus, in the mechanisms of speech and language . Int J Neuro 1971;;8:300-320.
19 +
Allan CM, Turner JW, Gadea-Ciria M:  Investigations into speech disturbances following stereotaxic surgery of parkinsonism . Br J Disord Commun 1966;;1:55-59.
20 +
Bell DS:  Speech functions of the thalamus inferred from the effects of thalamotomy . Brain 1968;;91:619-638.
21 +
Riklan M, Levita E, Zimmerman J, et al:  Thalamic correlates of language and speech . J Neurol Sci 1969;;8:307-328.
22 +
Guiot G, Hertzog E, Rondot P, et al:  Arrest or acceleration of speech evoked by thalamic stimulation in the course of stereotaxic procedures for parkinsonism . Brain 1961;;84:363-369.
23 +
Van Buren JM, Borke RC:  Alterations in speech and the pulvinar: A serial study of cerebrothalamic relationships in cases of acquired speech disorders . Brain 1969;;92:255-284.
24 +
Ojemann GA:  Asymmetric function of the thalamus in man . Ann NY Acad Sci 1977;;299:380-396.
25 +
Luria AR:  On quasi-aphasic speech disturbances in lesions of the deep structures of the brain . Brain Lang 1977;;4:432-439.
26 +
Panchal VG, Parikh JR, Karapurkar AP, quoted by Chesson AL:  Aphasia following a right thalamic hemorrhage . Brain Lang 1983;;19:306-316.
27 +
Kuo JS, Carpenter MB:  Organization of the pallidothalamic projections in the rhesus monkey . J Comp Neurol 1973;;151:201-236.
28 +
Nauta WJH, Mehler WR:  Projections of the lentiform nucleus in the monkey . Brain Res 1966;;1:3-42.
29 +
Scheibel ME, Scheibel AB:  The organization of the ventral anterior nucleus of the thalamus: A Golgi study . Brain Res 1966;;1:250-268.
30 +
Penfield W, Roberts L: Speech and Brain Mechanisms . Princeton, NJ, Princeton University Press, 1959;, 138-234.
31 +
Jonas S:  The thalamus and aphasia, including transcortical aphasia: A review . J Commun Disord 1982;;15:31-41.
32 +
Mesulam MM, Mufson EJ:  Insula of the old world monkey: III. Efferent cortical output and comments on function . J Comp Neurol 1982;; 212:38-52.
33 +
Ojemann GA:  Brain organization for language from the perspective of electrical stimulation mapping . Behav Brain Sci 1983;;6:189-230.
34 +
Purpura DP:  Operations and processes in the thalamic and synaptically related neural subsystems , in Schmitt FO (ed): The Neurosciences: Second Study Program . New York, The Rockefeller Foundation Press, 1970;.
35 +
Jones EG, Leavitt R:  Retrograde axonal transport and the demonstration of non-specific projections to the cerebral cortex and striatum from thalamic nuclei in the rat, cat and monkey . J Comp Neurol 1974;;154:349-378.
36 +
Jones EG:  Some aspects of the organization of the thalamic reticular complex . J Comp Neurol 1975;;162:285-308.
37 +
Jasper HH:  Unspecific thalamocortical relations , in Magoun HW (ed): Neurology Section: Handbook of Physiology . Baltimore, Williams & Wilkins Co, 1960;, pp 1307-1321.
38 +
Jasper HH:  Functional properties of the thalamic reticular system , in De la Fresnaye JF (ed): Brain Mechanisms and Consciousness . Oxford, England, Blackwell Scientific Publications, 1954;.
39 +
Skinner JE, Lindsley DB:  Electrophysiological and behavioral effects of blockage on the nonspecific thalamocortical system . Brain Res 1967;;6:95-117.
40 +
Velasco NE, Lindsley DB:  Role of orbital cortex in regulation of thalamocortical electrical activity . Science 1965;;149:1375-1377.
41 +
Fallon J, Benevento LA:  Projections of lateral orbital cortex to sensory relay nuclei in the rhesus monkey . Brain Res 1978;;144:149-154.

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1 +
Demeurisse G, Derouck M, Coekaerts M-J, et al:  A study of two cases of aphasia by infarction of the left thalamus, without cortical lesion . Acta Neurol Belg 1979;;79:450-459.
2 +
Cohen JA, Gelfer CE, Sweet RD:  Thalamic infarction producing aphasia . Mt Sinai J Med 1980;;47:389-404.
3 +
McFarling D, Rothi LJ, Heilman KM:  Transcortical aphasia from ischemic infarcts of the thalamus: A report of two cases . J Neurol Neurosurg Psychiatry 1982;;45:107-112.
4 +
Graff-Radford NR, Eslinger PJ, Damasio AR, et al:  Nonhemorrhagic infarction of the thalamus: Behavioral, anatomical and physiological correlates . Neurology 1983;;33( (suppl 2) ):164.
5 +
Fisher CM:  The pathologic and clinical aspects of thalamic hemorrhage . Trans Am Neurol Assoc 1959;;84:56-59.
6 +
Ciemins VA:  Localized thalamic hemorrhage: A cause of aphasia . Neurology 1970;; 20:776-782.
7 +
Mohr JP, Watters WC, Duncan GW:  Thalamic hemorrhage and aphasia . Brain Lang 1975;; 2:3-17.
8 +
Walshe TM, Davis KR, Fisher CM:  Thalamic hemorrhage: A computed tomographic-clinical correlation . Neurology 1977;;27:217-222.
9 +
Reynolds AF, Harris AB, Ojemann GA, et al:  Aphasia and left thalamic hemorrhage . J Neurosurg 1978;;48:570-574.
10 +
Reynolds AF, Turner PT, Harris AB, et al:  Left thalamic hemorrhage with dysphasia: A report of five cases . Brain Lang 1979;;7:62-73.
11 +
Cappa SF, Vignolo LA: ' Transcortical' features of aphasia following left thalamic hemorrhage . Cortex 1979;;15:121-130.
12 +
Alexander MP, LoVerme SR:  Aphasia after left thalamic intracerebral hemorrhage . Neurology 1980;;30:1193-1202.
13 +
Kirshner HS, Kistler KH:  Aphasia after right thalamic hemorrhage . Arch Neurol 1982;; 39:667-669.
14 +
Chesson AL:  Aphasia following a right thalamic hemorrhage . Brain Lang 1983;;19:306-316.
15 +
Smyth GE, Stern K:  Tumours of the thalamus: A clinico-pathological study . Brain 1938;; 61:339-374.
16 +
McKissock W, Paine KWE:  Primary tumours of the thalamus . Brain 1958;;81:41-63.
17 +
Cheek WR, Taveras JM:  Thalamic tumors . J Neurosurg 1966;;24:505-513.
18 +
Boetz MI, Barbeau A:  Role of subcortical structures, and particularly of the thalamus, in the mechanisms of speech and language . Int J Neuro 1971;;8:300-320.
19 +
Allan CM, Turner JW, Gadea-Ciria M:  Investigations into speech disturbances following stereotaxic surgery of parkinsonism . Br J Disord Commun 1966;;1:55-59.
20 +
Bell DS:  Speech functions of the thalamus inferred from the effects of thalamotomy . Brain 1968;;91:619-638.
21 +
Riklan M, Levita E, Zimmerman J, et al:  Thalamic correlates of language and speech . J Neurol Sci 1969;;8:307-328.
22 +
Guiot G, Hertzog E, Rondot P, et al:  Arrest or acceleration of speech evoked by thalamic stimulation in the course of stereotaxic procedures for parkinsonism . Brain 1961;;84:363-369.
23 +
Van Buren JM, Borke RC:  Alterations in speech and the pulvinar: A serial study of cerebrothalamic relationships in cases of acquired speech disorders . Brain 1969;;92:255-284.
24 +
Ojemann GA:  Asymmetric function of the thalamus in man . Ann NY Acad Sci 1977;;299:380-396.
25 +
Luria AR:  On quasi-aphasic speech disturbances in lesions of the deep structures of the brain . Brain Lang 1977;;4:432-439.
26 +
Panchal VG, Parikh JR, Karapurkar AP, quoted by Chesson AL:  Aphasia following a right thalamic hemorrhage . Brain Lang 1983;;19:306-316.
27 +
Kuo JS, Carpenter MB:  Organization of the pallidothalamic projections in the rhesus monkey . J Comp Neurol 1973;;151:201-236.
28 +
Nauta WJH, Mehler WR:  Projections of the lentiform nucleus in the monkey . Brain Res 1966;;1:3-42.
29 +
Scheibel ME, Scheibel AB:  The organization of the ventral anterior nucleus of the thalamus: A Golgi study . Brain Res 1966;;1:250-268.
30 +
Penfield W, Roberts L: Speech and Brain Mechanisms . Princeton, NJ, Princeton University Press, 1959;, 138-234.
31 +
Jonas S:  The thalamus and aphasia, including transcortical aphasia: A review . J Commun Disord 1982;;15:31-41.
32 +
Mesulam MM, Mufson EJ:  Insula of the old world monkey: III. Efferent cortical output and comments on function . J Comp Neurol 1982;; 212:38-52.
33 +
Ojemann GA:  Brain organization for language from the perspective of electrical stimulation mapping . Behav Brain Sci 1983;;6:189-230.
34 +
Purpura DP:  Operations and processes in the thalamic and synaptically related neural subsystems , in Schmitt FO (ed): The Neurosciences: Second Study Program . New York, The Rockefeller Foundation Press, 1970;.
35 +
Jones EG, Leavitt R:  Retrograde axonal transport and the demonstration of non-specific projections to the cerebral cortex and striatum from thalamic nuclei in the rat, cat and monkey . J Comp Neurol 1974;;154:349-378.
36 +
Jones EG:  Some aspects of the organization of the thalamic reticular complex . J Comp Neurol 1975;;162:285-308.
37 +
Jasper HH:  Unspecific thalamocortical relations , in Magoun HW (ed): Neurology Section: Handbook of Physiology . Baltimore, Williams & Wilkins Co, 1960;, pp 1307-1321.
38 +
Jasper HH:  Functional properties of the thalamic reticular system , in De la Fresnaye JF (ed): Brain Mechanisms and Consciousness . Oxford, England, Blackwell Scientific Publications, 1954;.
39 +
Skinner JE, Lindsley DB:  Electrophysiological and behavioral effects of blockage on the nonspecific thalamocortical system . Brain Res 1967;;6:95-117.
40 +
Velasco NE, Lindsley DB:  Role of orbital cortex in regulation of thalamocortical electrical activity . Science 1965;;149:1375-1377.
41 +
Fallon J, Benevento LA:  Projections of lateral orbital cortex to sensory relay nuclei in the rhesus monkey . Brain Res 1978;;144:149-154.

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