Abstract
OBJECTIVE: To determine if aphasia or neglect occurs after acute thalamic stroke without cortical hypoperfusion detected with dynamic contrast perfusion weighted imaging (PWI).
BACKGROUND: We previously reported that non-thalamic acute subcortical infarcts were associated with frank aphasia or hemispatial neglect only if accompanied by cortical hypoperfusion.
DESIGN/METHODS: We tested a series of 1471 patients on a battery of language tests (naming, comprehension, and repetition) for left hemisphere stroke patients or hemispatial neglect (line cancellation, a gap detection test, copying a scene) and visual and tactile extinction for right hemisphere stroke patients and obtained MRI scans with PWI within 48 hours of onset of stroke. Of these patients, we identified 8 patients with isolated left thalamic infarcts and 11 patients with isolated right thalamic infarcts. Volume of infarct and hypoperfusion were measured using Perfscape or ImageJ by a technician without prior knowledge of the cognitive scores. Spearman's correlations were calculated between cognitive scores and volumes of infarct or hypoperfusion.
RESULTS: There was no association between naming impairment and left cortical hypoperfusion by chi square; 3 of 8 patients with left thalamic infarcts had naming impairment, although only 2 had cortical hypoperfusion. However, 2/2 patients with comprehension deficit had cortical hypoperfusion (chi square=8; p=.008). Error rates in comprehension were not correlated with volume of infarct or volume of hypoperfusion. Only 2/ 11 patients with right thalamic infarcts had hemispatial neglect, and both had cortical hypoperfusion (chi square=11; p=.001). Deviation to the right on line bisection (indicating severity of neglect) was correlated with volume of thalamic lesion volume of cortical hypoperfusion (rho=.67; p=.02).
CONCLUSIONS: Isolated left thalamic infarcts can cause naming impairment (perhaps via diaschisis) without cortical hypoperfusion, irrespective of lesion volume. However, thalamic neglect (and comprehension impairments) may be largely due to cortical hypoperfusion.
Supported by: R01 DC 05375 and R01 NS047691 and R01 DC03681.
Disclosure: Dr. Schein has nothing to disclose. Dr. Sebastian has nothing to disclose. Dr. Hillis has received personal compensation in an editorial capacity for Behavioural Neurology. Dr. Hillis has received research support from Allon Pharmaceutical.
Monday, March 18 2013, 2:00 pm-6:30 pm
- Copyright © 2013 by AAN Enterprises, Inc.
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