Abstract Details

Title Are Thalamic Aphasia and Neglect Due to Cortical Hypoperfusion?

Topic Behavioral Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 004

Objective

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.

Authors/Disclosures
PRESENTER	No disclosure on file
Rajani Sebastian, PhD (Neurology)	No disclosure on file
Argye E. Hillis, MD, MA (Johns Hopkins Hospital)	Dr. Hillis has received personal compensation for serving as an employee of Johns Hopkins University. Dr. Hillis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Hillis has received research support from NIH. Dr. Hillis has received publishing royalties from a publication relating to health care. Dr. Hillis has received personal compensation in the range of $500-$4,999 for serving as a NIDCD Council Member with NIH.
Per Soelberg Sorensen	No disclosure on file

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