Recently, we had a 39 year-old man on our hospitalist service who presented with transient hemiplegia, diplopia, and somnolence. A brain MRI showed an acute stroke in the distribution of the thalamo-geniculate pedicle. By the end of his hospitalization, his mental status and motor abilities had normalized but he retained an interesting pattern of aphasia. He had a great deal of word-finding difficulty, although his speech was fluent and he could follow commands easily.
Here, I asked him to read aloud a word I'd written on a sheet of paper:
He said: "Cherry."
Then I showed him two objects and asked him to write down the word for each. The first object was a banana. The patient wrote "banana" with difficulty, using his dominant hand. Then he asked, "Can I use my other hand?" I said yes, and showed him the second object, a watch. He wrote "watch" using his nondominant (left) hand much more fluently.
That is the extent of my bedside neurological assessment of higher-order functions. Anyone else have any experience with thalamic stroke?
Ischemic strokes are caused by a blood clot or blockages in the arteries, and hemorrhagic strokes occur when blood vessels rupture. Ischemic strokes are most commonly caused by blockages in the carotid arteries and are responsible for up to 80% of strokes. As people age, arteries become narrowed with rough deposits of plaque called "stenosis". Diseased arteries can clog up completely as the plaque accumulates or can be shut down by clotting conditions called "embolism" and "thrombosis". When the arteries become plugged, the blood is no longer able to reach the brain and stroke results.
Posted by: sudden stroke | December 22, 2009 at 08:07 AM
Can't comment on the defect, but this encouraging (?) story was in the NYT a couple days ago: http://www.nytimes.com/2008/09/11/sports/othersports/11gold.html?em
Posted by: DrMidlife | September 12, 2008 at 09:36 AM