1/19. Cataleptic postures in thalamic hemorrhage: case report.We report a case of catalepsy associated with thalamic hemorrhage. A 72 year-old hypertensive woman had acute onset of right-sided weakness and speech disturbances. She was on anticoagulants because of aortic valve replacement. When postures were imposed, the patient maintained the left upper limb raised for several minutes, even in uncomfortable or bizarre positions. A CT scan of the head revealed a left thalamic hemorrhage. Cataleptic postures have been reported in few cases with acute stroke.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
2/19. Bilateral paramedian thalamic infarct in the presence of an unpaired thalamic perforating artery.Bilateral paramedian thalamic infarction is rare. The suggested mechanism is occlusion of a central unpaired thalamic perforating artery--an anatomic variant. In the few existing reports of this condition, the diagnosis was based on computed tomography (CT) or magnetic resonance imaging (MRI) findings alone. Other causes of thalamic lesions were not ruled out, and there was no angiographic demonstration of the presumed variant artery. We present a case of a 48-year-old man with a bilateral thalamic infarction seen on CT and MRI. Initial neurological examination revealed lethargy, severe combined motor and sensory aphasia, and a mild upward gaze limitation. The patient had no focal motor deficits. After 24 hours, the patient was more alert and his speech became more fluent, but Korsakoff-type amnesia with poor attention span became apparent. The patient improved slowly over 6 months of rehabilitation. Bilateral thalamic lesions can be caused by several conditions. Among those are thiamine deficiency, cerebral lupus, toxoplasmosis, cysticercosis, cerebral syphilitic gumma, and even tumors and fungal infections. All these were ruled out in our case. Superselective digital subtraction angiography (DSA) demonstrated a single unpaired thalamic perforator. To our knowledge, this is the first time this anatomical variant has been demonstrated in vivo in association with bilateral thalamic infarction.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
3/19. Diagnostic difficulties in childhood bilateral thalamic astrocytomas.We report on two children with bilateral thalamic astrocytomas. The first patient developed psychomotor regression at the age of 20 months followed by rapidly progressive ataxia, intention tremor, slurred speech, and bouts of drowsiness. magnetic resonance imaging (MRI) of the brain showed swelling and high signal intensity in both thalami accompanied by supratentorial hydrocephalus. The second patient presented with progressive cerebellar ataxia, headache, and vomiting at the age of 11 years. MRI of the brain revealed symmetrical, hyperintense and sharply delineated swelling of both thalami. Additional lesions were seen in the cerebellum and the right temporal lobe. In both cases proton magnetic resonance spectroscopy (MRS) of the lesions showed a striking decrease of the neuronal marker N-acetylaspartate, an increase of choline-containing compounds, and a minimal lactate peak. Stereotactic biopsies from the thalamus of the first patient and from a cerebellar lesion of the second patient finally revealed glial tumors, namely a diffuse astrocytoma of world health organization (WHO) grade II in the first patient and an anaplastic astrocytoma of WHO grade III in the second patient. We conclude that the clinical manifestations and MRI patterns of bilateral thalamic astrocytomas are very similar to those of encephalitis and neurometabolic disorders and should therefore be included in the differential diagnosis of these encephalopathies.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
4/19. Acute bilateral thalamic necrosis in a child with mycoplasma pneumoniae.A previously neurodevelopmentally intact 5-year-old male was admitted to hospital with a right lower lobe pneumonia with pleural effusion, subsequently confirmed to be a mycoplasma pneumoniae infection. On the seventh day of the illness he had a prolonged generalized tonic or tonic-clonic convulsion, requiring intubation and ventilation. He was slow to regain consciousness (child's Glasgow coma Score 7-10 over 6 days) and brain imaging with CT and then MRI demonstrated bilateral thalamic lesions with oedema and central haemorrhage suggestive of acute bilateral thalamic necrosis, without striatal or white-matter involvement. He was treated with a 2-week course of erythromycin, and as an autoimmune process was considered possible, 5 days of intravenous methylprednisolone (20 mg/kg/day) followed by a 4-week oral prednisolone taper. He made a slow recovery over the next few weeks with almost complete neurological recovery by 2 months but with significant dysarthria, drooling, and a mild left hemiparesis. At 9 months, significant dystonia continued to affect his speech and, together with tremor, his upper-limb fine motor function bilaterally. His gait, personality, and higher cognitive functions appeared to have recovered fully. Although acute striatal necrosis, acute disseminated encephalomyelitis, and encephalitis have been reported with mycoplasma pneumoniae and a similar picture of acute bilateral thalamic necrosis with influenza-A ('acute necrotizing encephalopathy'), this is the first reported case of mycoplasma pneumoniae-associated isolated acute bilateral thalamic necrosis.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
5/19. Hypersexuality and dysexecutive syndrome after a thalamic infarct.Hypersexuality can result from insults to several neuroanatomical structures that regulate sexual behavior. A case is presented of an adult male with a thalamic infarct resulting in a paramedian thalamic syndrome, consisting of hypersomnolence, confabulatory anterograde amnesia (including reduplicative paramnesia), vertical gaze deficits, and hypophonic speech. A dysexecutive syndrome also manifested, consisting of social disinhibition, apathy, witzelsucht, motor inhibition deficits, and environmental dependence. Hypersexuality uncharacteristic of his premorbid behavior was evident in instances of exhibitionism, public masturbation, and verbal sexual obscenities. In contrast to the few previous reports of hypersexuality following thalamic infarct, this case neither involved mania nor hemichorea. The relevance of the mediodorsal thalamic nucleus in limbic and prefrontal circuits is discussed.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
6/19. language disorder in a child with early left thalamic lesion.In this paper we present the case of a child with early left thalamic vascular damage who subsequently developed a language disorder. At 3 years and 8 months, her language was poor and unintelligible and showed phonetic, phonological and morpho-syntactic disorders. She did not exhibit any signs of mental retardation. After specific speech therapy, she improved in all linguistic skills. Given the lack of reports on thalamic lesions in children, this paper describes the effect of a thalamic injury in the earliest phases of language acquisition in a child who showed consistent phonological disorders. This case seems to confirm early hemispheric specialisation and the importance of a timely therapy.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
7/19. Impairment of syntax and lexical semantics in a patient with bilateral paramedian thalamic infarction.Bilateral vascular thalamic lesions are rare. Although a variety of neurobehavioral manifestations have been described, the literature is less documented with regard to accompanying linguistic disturbances. This article presents an in-depth neurolinguistic analysis of the language symptoms of a patient who incurred bilateral paramedian ischemic damage of the thalamus. In the post-acute phase of the stroke, a unique combination of transcortical sensory aphasia with syntactic impairment was found. Because of this atypical semiological association, additional analyses of spontaneous speech were performed. In spite of the typological affinity with the grammatic characteristic of marked simplification of syntax observed in Broca's aphasia, only a wordclass specific, lexical-semantic deficit for verbs was objectified. The hypothesis that lexical-semantic disturbances in our patient might result from a functional deafferentiation of both thalami with the frontal lobe is supported by: (1) associated neuropsychological deficits of frontal origin and (2) frontal-like behavioral disturbances.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
8/19. Primary thalamic malignant fibrous histiocytoma of the dominant hemisphere causing severe neuropsychological symptoms.A 45-year-old man with a malignant fibrous histiocytoma (MFH) of the left thalamus is reported. This tumor only rarely originates within the brain. Primarily intracerebral MFH usually has a superficial localization and rarely involves the deep cerebral structures. Our patient presented with complex neuropsychological symptoms, including aphasia, hemispatial neglect and acalculia. These findings are further supporting evidence for the role of the thalamus, particularly of its posterior parts, in language, speech and other neuropsychological functions.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
9/19. Surgical approach to large thalamic gliomas.Fifteen cases of large thalamic gliomas were treated by laser surgery and CUSA under X8 magnification and subsequently they were subjected to radiotherapy. More than 50% of the tumours were located in the dominant hemisphere and therefore an interhemispheric approach was carried out to avoid disturbances of speech and field defects. Nine patients had astrocytomas grade II and the remaining six had astrocytomas grades III-IV. The quality and survival has been gratifying in the less malignant gliomas. The operative technique and use of Laser and CUSA is highlighted.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
10/19. aphonia as the only speech disturbance from bilateral paramedian thalamic infarction.We examined a 55-year-old right-handed woman showing transient coma, amnesia, mild right hemiparesis, vertical gaze impairment and aphonia without aphasia. CT-scanning revealed bilateral paramedian thalamic infarction in the territory of the thalamo-subthalamic paramedian arteries. aphonia may occur as a consequence of thalamic lesions, but until now it has not been described as an isolated speech disturbance.- - - - - - - - - - ranking = 5keywords = speech (Clic here for more details about this article) |
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