Cases reported "Thalamic Diseases"

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1/5. aphonia due to paramedian thalamo-subthalamic infarction. Remarks on two cases.

    We describe two patients in whom CT brain scans imaged paramedian thalamo-subthalamic infarcts in the territory of the thalamo-mesencephalic arteries. Such infarcts give rise to a complex syndrome marked by disturbances of consciousness and of eye movement and neuropsychological disorders, including attentional, memory and, more rarely, language deficits. A loss of voice volume may accompany aphasic disturbances but is exceedingly rare in isolation. In the cases described the aphonia, total but transient, was the only language disorder. The physiopathological mechanisms involved in aphonia are complex and controversial.
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keywords = voice
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2/5. Cerebral blood flow in thalamic aphasia.

    A 59-year-old man is reported, who became aphasic after left thalamic infarction, shown by CT. His speech was fluent, with reduced voice volume, impaired auditory and reading comprehension, verbal paraphasias but intact repetition skills. A single photon emission computed tomography (SPECT) scan to measure regional cerebral flow (rCBF) showed a reduction of flow in the parietotemporal areas of the left hemisphere. It is suggested that thalamic aphasia could result from structural subcortical damage with a homolateral functional cortical deficit leading to the specific aphasic disturbance.
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3/5. aphasia following right thalamic hemorrhage in a dextral.

    A 74-year-old, right-handed woman with a right thalamic hemorrhage and aphasia is described. Sequential neurologic examinations and aphasia testing were carried out during a 1-year period and the results are reported. The patient exhibited a language deficit resembling a transcortical aphasia in the acute stage. Reduced spontaneous speech, fading voice volume, fluent verbal output with paraphasia, anomia, and a mild comprehension difficulty were present. Repetition was good. At 1 year postonset, the primary language problem exhibited by the patient was in object naming, all other components of the original language deficit having shown good recovery. This is the first reported case of right thalamic involvement in speech/language in the absence of personal and familial sinistrality.
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4/5. aphasia following a right thalamic hemorrhage.

    A left-handed patient with a right thalamic hemorrhage and disordered speech is described. Sequential examinations and aphasia testing were done during a 1-year follow-up period and the results are reported. This case supports those authors who have described characteristics they feel are helpful in diagnosing disordered speech associated with thalamic lesions. Paucity of speech, reduced voice volume, anomia, some paraphasia, and severe dysgraphia were present, but comprehension and repetition were relatively preserved. She showed modest improvement with time. This case also confirms that thalamic involvement in speech is a dominant, rather than a specifically left hemispheric function.
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keywords = voice
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5/5. aphasia after left thalamic infarction.

    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.
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