Aphasia and left thalamic hemorrhage

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Abstract
Left thalamic hemorrhage as a cause of aphasia is not widely recognized. Large thalamic hemorrhages cause coma, making speech examination impossible; smaller thalamic hemorrhages were difficult to document until recent diagnostic advances. Nine cases of thalamic hemorrhage with aphasia were described in the literature. This report presents 4 additional cases. These patients had acute onset of aphasia, supranuclear paralysis of upward gaze, right hemisensory deficits and mild right hemiparesis. Of the 4 patients, 3 responded to ventriculostomy drainage with rapid clearing of the supranuclear paralysis of upward gaze, and 2 later required placement of permanent ventricular shunts. After 1 yr, 2 patients exhibited no clinically detectable speech malfunction and the other 2 were severely aphasic. The hemiparesis, hemisensory deficts and ocular pareses all cleared. These cases were discussed with respect to present models of the role of the thalamus in speech.

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