Speech disorder and behavioral involvement in a thalamic stroke: a case report

Data from literature on clinical manifestation of thalamic strokes have been published for ages. First in 1906 Dejerine e Roussy have spoken about sensorymotor disturbances and have opened the door to new pathologic disorders that may occur after thalamic lesions. From 1925 behavior and speech disorders related with thalamic injury were described. Since then a classification of thalamic syndromes into four groups based on the four main arterial territories was accepted. As we know thalamic stroke account for 11% of vertebra basilar infarct. Inferolateral territory infarctions are the most common injury (45%), followed by the paramedian territory infarctions (35%) and the anterior territory lesions (12%), the posterior territory infarctions are less frequent (8%). Anyway lots of symptoms cannot still be classified easily and strictly into only one of this four groups and several variant topographic patterns of thalamic strokes with distinct manifestation and etiology have been proposed. Here we described the case of one young Caucasian man that was admitted to the emergency department for a sudden onset of dizziness with left lateropulsion, vertigo, visual impairment and speech disorder involving unpredictable topic shifts but grammatically correct. During recovery patient performed a typical behavior disorder consisting mainly in lack of emotion and memory long or short term loss. Magnetic resonance was performed and showed left thalamic infarction involving paramedian territory. The complex cognitive and behavioral disorders described can be explaned only supporting the already described different topographic patterns of thalamic infarction