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?