Bilateral Neuropsychological Deficits in Unilateral Paramedian Thalamic Infarction

Baumgartner, Ralf W.; Regard, Marianne

doi:10.1159/000116935

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…The initial symptoms cleared however, and the patient showed a residual amnesia for non-verbal material only. By contrast with the reports mentioned above,6 39-43 and similar to our study, Baumgartner and Regard reported three patients with right sided infarctions of the thalamus, two of whom showed evidence of bilateral neuropsychological deficits 44. Unfortunately, no pictures or reconstructions of the lesions are presented and it is therefore impossible to judge whether the lesions are similar to the one described in the present paper.…”

Section: Discussioncontrasting

confidence: 72%

Neuropsychological correlates of a right unilateral lacunar thalamic infarction

Werf

Weerts

Jolles

et al. 1999

Journal of Neurology, Neurosurgery & Psychiatry

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Objectives-To report on a patient with a lacunar infarction in the right intralaminar nuclei of the thalamus. The role of the thalamic intralaminar nuclei in cognitive function is as yet insuYciently known. The patient described has shown signs of apathy and loss of initiative, in combination with cognitive deficits, which have persisted essentially unaltered up to the present day since an abrupt onset 17 years ago. Methods-High resolution MRI was performed to show the extent of the lesion; a combination of published and experimental neuropsychological techniques was administered to show the nature of the cognitive defects; Single photon emission computed tomography (SPECT) was employed to obtain a measure of cortical perfusion. Results-Brain MRI disclosed an isolated lacunar infarction in the dorsal caudal intralaminar nuclei of the thalamus. Neuropsychological evaluation indicated problems with attention and concentration, executive disturbances, and memory deficits both in the visual and verbal domains. The memory deficits could not be attributed to problems in the early stages of information processing, and are hence regarded as resulting from a failure of retrieval rather than encoding or storage. Brain SPECT disclosed a hypoperfusion of the right frontal cortex. Conclusion-The data indicate that the cognitive profile is the result of a dysfunction of executive functions. This is corroborated by the finding of decreased blood flow in the right frontal cortex, and by evidence from the neuroanatomical literature. Thus the dysexecutive symptoms are thought to be caused by disconnection of the prefrontal cortex from the brainstem activating nuclei through the strategic localisation of the right thalamic infarction. (J Neurol Neurosurg Psychiatry 1999;66:36-42)

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Section: Discussioncontrasting

confidence: 72%

Neuropsychological correlates of a right unilateral lacunar thalamic infarction

Werf

Weerts

Jolles

et al. 1999

Journal of Neurology, Neurosurgery & Psychiatry

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“…3,[5][6][7][8][9][10] With the improvement of consciousness, neuropsychological problems such as executive, learning, and memory deficits become more evident. 1,3,5,6,9,[11][12][13][14][15] Sleep studies have shown an increased sleep duration with predominance of superficial sleep stages, increased sleep fragmentation, and decreased sleep spindles. [2][3][4] Hypersomnia has been considered to result from the disruption of thalamic sleep-generating and arousal-maintaining mechanisms.…”

mentioning

confidence: 99%

Evolution of Neurological, Neuropsychological and Sleep-Wake Disturbances After Paramedian Thalamic Stroke

Hermann

Siccoli

Brugger

et al. 2008

Stroke

152

139

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Background and Purpose-The clinical features and natural course of paramedian thalamic stroke is poorly known. The aim of this study was to characterize the evolution of neurological, neuropsychological, and sleep-wake deficits after paramedian thalamic stroke. Methods-Forty-six consecutive patients, aged 48.4Ϯ16.6 years, were studied. Fourteen had bilateral, 16 left-sided, and 16 right-sided lesions. Assessment included neurological examinations, estimation of sleep needs, formal neuropsychological tests (nϭ27), and polysomnographies (nϭ31). Functional outcome was followed up over 1 year in 31 patients with the modified Rankin Scale and Barthel index. Results-Oculomotor palsy (76% of patients), mild gait ataxia (67%), deficits of attention (63%), fluency and error control (59%), learning and memory (67%), and behavior (67%) were common in the acute stroke phase. Outcome was excellent with right-sided infarcts but mostly incomplete with bilateral and left-sided lesions. This was mainly related to persistent frontal lobe-related and cognitive deficits found in 100% bilateral and 90% left-sided, but only 33% right-sided strokes. Initially, hypersomnia was present in all patients associated with increased stage 1 sleep, reduced stage 2 sleep, and reduced sleep spindles. Sleep needs improved in patients with bilateral and almost disappeared with unilateral lesions after 1 year. Sleep architecture remained abnormal with the exception of sleep spindles that increased. Conclusions-Whereas neurological deficits and hypersomnia recover to large extent in patients with paramedian thalamic stroke, the frontal lobe-related and cognitive deficits, which are mainly linked with bilateral and left-sided lesions, often persist. As such, stroke outcome is better in right-sided than bilateral or left-sided infarcts. (Stroke. 2008;39:62-68.)

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“…Baumgartner and Regard, 1993). This relationship has been observed in several PET studies in which bilateral cortical and subcortical metabolic depression was detected after unilateral subcortical lesions (Szelies et al, 1991).…”

Section: When Neuropsychological Findings Are Not Mirrored By Resultsmentioning

confidence: 53%

Commonalities and Discrepancies in the Relationships between Behavioural Outcome and the Results of Neuroimaging in Brain-Damaged Patients

Markowitsch

Calabrese

1996

Behavioural Neurology

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Variables which are of influence in establishing clear predictions of neuropsychological alterations from neuroradiological data (and vice versa) are documented and discussed. It is concluded that personality factors and the kind and locus of brain lesions are the most crucial determinants. The locus of the brain damage may have cumulative effects either when it is situated in a strategic place (usually within the white matter, affecting interneuronal communication) or when various types of lesions appear superimposed (combination of focal and diffuse lesions). Consequently, the consideration of the patient's personality background and of as many neuropsychological facts as possible may considerably increase the validity of outcome predictions. When static or dynamic neuroimaging fails to show abnormalities in spite of obvious psychological alterations, an intensive neuropsychological documentation may even replace neuroradiology. Keywords: Brain damage -Magnetic resonance imaging -Computer tomography -Neuropsychological assessment INTRODUCTIONThe availability of cranial computer tomography (CT) has revolutionized the diagnostic power for patients with brain damage, and the subsequent appearance of magnetic resonance imaging (MRI), positron emission tomography (PET) and functional magnetic resonance imaging has further increased and refined the power of relating brain tissue changes to behavioural alterations. Nevertheless, there are numerous case reports in which neuroimaging and neuropsychological data indicate a different prognosis, thereby leading to an improper rehabilitation treatment of the patient.Part of the discrepancy may be explained by the false assumption of linear relationships between lesion size and behavioural outcome (e.g. Irle, 1987Irle, , 1990Grafman et al., 1986), but other parts are most likely due to insensitive measurement on the imaging or the psychological level. Alesch et al. (1991), for instance, found that CT is quite insensitive to the identification of lymphomas although gliomas are readily detected. Similarly, although subdural empyemas and most sterile effusions and chronic subdural haematomas appear similar in CT scans, they are (~ 1996 Rapid Science Publishers much more readily distinguishable on the basis of signal intensity differences in MRI (Takamura et al., 1995);and Kertesz et al. (1987) concluded from their analyses that MRI surpasses CT scanning in the early detection of cerebral infarcts. CT on the other hand should be the method of choice to rule out intracerebral bleeding when a patient is screened initially. For detecting anatomical correlates of abnormal behavioural functioning, such as in psychogenic amnesia, conventional static imaging techniques have been useless up to now, although dynamic methods, such as PET imaging, may reveal cerebral blood flow changes indicative of abnormal processing (Amsterdam and Mozley, 1992;Markus et al., 1992).Congruence and incongruence of neuropsychology and neuroradiology are the topics of this commentary. We will first illustr...

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Bilateral Neuropsychological Deficits in Unilateral Paramedian Thalamic Infarction

Cited by 12 publications

References 15 publications

Neuropsychological correlates of a right unilateral lacunar thalamic infarction

Neuropsychological correlates of a right unilateral lacunar thalamic infarction

Evolution of Neurological, Neuropsychological and Sleep-Wake Disturbances After Paramedian Thalamic Stroke

Commonalities and Discrepancies in the Relationships between Behavioural Outcome and the Results of Neuroimaging in Brain-Damaged Patients

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