Thalamic hemorrhage and aphasia

doi:10.1016/S0093-934X(75)80050-2

Brain and Language

Volume 2, 1975, Pages 3-17

https://doi.org/10.1016/S0093-934X(75)80050-2 Get rights and content

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.

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The thalamus has a demonstrated role in language, particularly through its connectivity to frontal language cortices.
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The role of thalamic nuclei in language processes and other reports of transient thalamic aphasia are reviewed.
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In a study conducted in 1990, Wyllie et al. determined hemispheric dominance for language by using Wada testing and defined the speech-related regions in the dominant hemisphere as posterior temporal (Wernicke’s area), frontal (Broca’s area), and basal temporal regions [28]. Recent studies, however, have shown that aphasia may be present in other deep brain regions such as thalamus and thalamic lesions are associated with aphasia [29–31]. Based on these findings, it is tempting to consider that the speech center may not necessarily be localized in a specific region in the dominant hemisphere but rather can affect multiple regions including deep brain structures.
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The role of the thalamus in language remains a matter of debate. Multiple thalamic nuclei (e.g., pulvinar, intralaminar nuclei, and the ventral tier nuclei) are implicated in language, as indicated by their connectivity with the cortex and lesion data. Lesions of the dominant thalamus may produce difficulties in naming with relative preservation of other functions such as repetition. In addition, dominant thalamic lesions are associated with fluctuations in language performance based on overall level of arousal, perseverations, and relatively rapid recovery. Bilateral thalamic activations (with left greater than right responses), along with activation of traditional cortical areas associated with language, are seen in functional imaging studies of human subjects during covert naming and sentence generation tasks. Potential thalamic mechanisms underlying language behavior are multiple and are discussed within this chapter.
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Two distinct developments in the decade prior to the Brain and Language 1975 “state of the art” review challenged that view. The first evidence came from the ability to more frequently identify spontaneous thalamic lesions during life and thus assess language function (Fisher, 1959), particularly with the advent of computerized tomographic scanning (Mohr, Watters, & Duncan, 1975); further was the recognition of language deficits independent of changes in general alertness after stereotaxic thalamic lesions placed for the treatment of movement disorders (Bell, 1968; Selby, 1967). The evidence from both approaches suggested lateralization of thalamic function with a special language role for left thalamus.
Regionalization of language function within the left thalamus has been established with language and verbal memory effects of thalamic stimulation during surgery for movement disorders. Three distinct language effects of thalamic stimulation were established: anomia from posterior ventrolateral (VL) and pulvinar regions; perseveration from mid-VL regions; and, a memory and acceleratory effect from anterior VL, described as a “specific alerting response” (SAR). These studies are reviewed in context of pertinent contemporary and recent literature on the thalamic role in memory and language. An explicit mechanistic model for the anomia and SAR effect is proposed. The suggested model for the SAR effect involves secondary switching in the striatum by the activation of thalamostriatal projections, whereas the anomia effect implicates the disruption of the cortical synchronization action of pulvinar via the cortico-pulvinar–cortical projection system. Further experimental data is required to firmly establish these mechanisms.
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¹: This paper was supported by grants HL 14888-02 and NS 10828-01A1.

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Thalamic hemorrhage and aphasia1

Lancet

Speech functions of the thalamus inferred from the effects of Thalamotomy

Brain

Conduction aphasia

Arch. Neurol.

Role of subcortical structures, and particularly of the thalamus in the mechanisms of speech and language

Int. J. Neurol.

Localized Thalamic Hemorrhage

Neurology

The pathologic and clinical aspects of thalamic hemorrhage

Trans. Amer. Neurol. Ass.

Pure sensory strike involving face, arm, and leg

Neurology

Pure motor hemiplegia of vascular origin

Arch. Neurol.

Cerebrovascular disorders