Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Jan;66(1):36–42. doi: 10.1136/jnnp.66.1.36

Neuropsychological correlates of a right unilateral lacunar thalamic infarction

Y Werf 1, J Weerts 1, J Jolles 1, M Witter 1, J Lindeboom 1, P Scheltens 1
PMCID: PMC1736166  PMID: 9886448

Abstract

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 insufficiently 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.



Full Text

The Full Text of this article is available as a PDF (149.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baron J. C., D'Antona R., Pantano P., Serdaru M., Samson Y., Bousser M. G. Effects of thalamic stroke on energy metabolism of the cerebral cortex. A positron tomography study in man. Brain. 1986 Dec;109(Pt 6):1243–1259. doi: 10.1093/brain/109.6.1243. [DOI] [PubMed] [Google Scholar]
  2. Baron J. C., Levasseur M., Mazoyer B., Legault-Demare F., Mauguière F., Pappata S., Jedynak P., Derome P., Cambier J., Tran-Dinh S. Thalamocortical diaschisis: positron emission tomography in humans. J Neurol Neurosurg Psychiatry. 1992 Oct;55(10):935–942. doi: 10.1136/jnnp.55.10.935. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Baumgartner R. W., Regard M. Bilateral neuropsychological deficits in unilateral paramedian thalamic infarction. Eur Neurol. 1993;33(3):195–198. doi: 10.1159/000116935. [DOI] [PubMed] [Google Scholar]
  4. Berendse H. W., Groenewegen H. J. Restricted cortical termination fields of the midline and intralaminar thalamic nuclei in the rat. Neuroscience. 1991;42(1):73–102. doi: 10.1016/0306-4522(91)90151-d. [DOI] [PubMed] [Google Scholar]
  5. Bogousslavsky J., Ferrazzini M., Regli F., Assal G., Tanabe H., Delaloye-Bischof A. Manic delirium and frontal-like syndrome with paramedian infarction of the right thalamus. J Neurol Neurosurg Psychiatry. 1988 Jan;51(1):116–119. doi: 10.1136/jnnp.51.1.116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bogousslavsky J., Regli F., Assal G. The syndrome of unilateral tuberothalamic artery territory infarction. Stroke. 1986 May-Jun;17(3):434–441. doi: 10.1161/01.str.17.3.434. [DOI] [PubMed] [Google Scholar]
  7. Bogousslavsky J., Regli F., Delaloye B., Delaloye-Bischof A., Assal G., Uske A. Loss of psychic self-activation with bithalamic infarction. Neurobehavioural, CT, MRI and SPECT correlates. Acta Neurol Scand. 1991 May;83(5):309–316. doi: 10.1111/j.1600-0404.1991.tb04708.x. [DOI] [PubMed] [Google Scholar]
  8. Bogousslavsky J., Regli F., Uske A. Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology. 1988 Jun;38(6):837–848. doi: 10.1212/wnl.38.6.837. [DOI] [PubMed] [Google Scholar]
  9. Brand N., Jolles J. Learning and retrieval rate of words presented auditorily and visually. J Gen Psychol. 1985 Apr;112(2):201–210. doi: 10.1080/00221309.1985.9711004. [DOI] [PubMed] [Google Scholar]
  10. Daum I., Ackermann H. Frontal-type memory impairment associated with thalamic damage. Int J Neurosci. 1994 Aug;77(3-4):187–198. doi: 10.3109/00207459408986030. [DOI] [PubMed] [Google Scholar]
  11. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  12. Graff-Radford N. R., Eslinger P. J., Damasio A. R., Yamada T. Nonhemorrhagic infarction of the thalamus: behavioral, anatomic, and physiologic correlates. Neurology. 1984 Jan;34(1):14–23. doi: 10.1212/wnl.34.1.14. [DOI] [PubMed] [Google Scholar]
  13. Graff-Radford N. R., Tranel D., Van Hoesen G. W., Brandt J. P. Diencephalic amnesia. Brain. 1990 Feb;113(Pt 1):1–25. doi: 10.1093/brain/113.1.1. [DOI] [PubMed] [Google Scholar]
  14. Groenewegen H. J., Berendse H. W. The specificity of the 'nonspecific' midline and intralaminar thalamic nuclei. Trends Neurosci. 1994 Feb;17(2):52–57. doi: 10.1016/0166-2236(94)90074-4. [DOI] [PubMed] [Google Scholar]
  15. Kinomura S., Larsson J., Gulyás B., Roland P. E. Activation by attention of the human reticular formation and thalamic intralaminar nuclei. Science. 1996 Jan 26;271(5248):512–515. doi: 10.1126/science.271.5248.512. [DOI] [PubMed] [Google Scholar]
  16. Koger S. M., Mair R. G. Comparison of the effects of frontal cortical and thalamic lesions on measures of olfactory learning and memory in the rat. Behav Neurosci. 1994 Dec;108(6):1088–1100. doi: 10.1037//0735-7044.108.6.1088. [DOI] [PubMed] [Google Scholar]
  17. Kopelman M. D., Stanhope N. Rates of forgetting in organic amnesia following temporal lobe, diencephalic, or frontal lobe lesions. Neuropsychology. 1997 Jul;11(3):343–356. doi: 10.1037//0894-4105.11.3.343. [DOI] [PubMed] [Google Scholar]
  18. Kritchevsky M., Graff-Radford N. R., Damasio A. R. Normal memory after damage to medial thalamus. Arch Neurol. 1987 Sep;44(9):959–962. doi: 10.1001/archneur.1987.00520210055019. [DOI] [PubMed] [Google Scholar]
  19. Levasseur M., Baron J. C., Sette G., Legault-Demare F., Pappata S., Mauguière F., Benoit N., Tran Dinh S., Degos J. D., Laplane D. Brain energy metabolism in bilateral paramedian thalamic infarcts. A positron emission tomography study. Brain. 1992 Jun;115(Pt 3):795–807. doi: 10.1093/brain/115.3.795. [DOI] [PubMed] [Google Scholar]
  20. Lindeboom J., Matto D. Cijferreeksen en Knox blokken als concentratietests voor ouderen. Tijdschr Gerontol Geriatr. 1994 May;25(2):63–68. [PubMed] [Google Scholar]
  21. Mair R. G., Lacourse D. M. Radio-frequency lesions of the thalamus produce delayed-nonmatching-to-sample impairments comparable to pyrithiamine-induced encephalopathy in rats. Behav Neurosci. 1992 Aug;106(4):634–645. doi: 10.1037//0735-7044.106.4.634. [DOI] [PubMed] [Google Scholar]
  22. Mennemeier M., Crosson B., Williamson D. J., Nadeau S. E., Fennell E., Valenstein E., Heilman K. M. Tapping, talking and the thalamus: possible influence of the intralaminar nuclei on basal ganglia function. Neuropsychologia. 1997 Feb;35(2):183–193. doi: 10.1016/s0028-3932(96)00062-0. [DOI] [PubMed] [Google Scholar]
  23. Mennemeier M., Fennell E., Valenstein E., Heilman K. M. Contributions of the left intralaminar and medial thalamic nuclei to memory. Comparisons and report of a case. Arch Neurol. 1992 Oct;49(10):1050–1058. doi: 10.1001/archneur.1992.00530340070020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Ojemann G. A. Asymmetric function of the thalamus in man. Ann N Y Acad Sci. 1977 Sep 30;299:380–396. doi: 10.1111/j.1749-6632.1977.tb41923.x. [DOI] [PubMed] [Google Scholar]
  25. Pepin E. P., Auray-Pepin L. Selective dorsolateral frontal lobe dysfunction associated with diencephalic amnesia. Neurology. 1993 Apr;43(4):733–741. doi: 10.1212/wnl.43.4.733. [DOI] [PubMed] [Google Scholar]
  26. Peru A., Fabbro F. Thalamic amnesia following venous infarction: evidence from a single case study. Brain Cogn. 1997 Apr;33(3):278–294. doi: 10.1006/brcg.1997.0868. [DOI] [PubMed] [Google Scholar]
  27. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975 Oct;23(10):433–441. doi: 10.1111/j.1532-5415.1975.tb00927.x. [DOI] [PubMed] [Google Scholar]
  28. Rombouts S. A., Machielsen W. C., Witter M. P., Barkhof F., Lindeboom J., Scheltens P. Visual association encoding activates the medial temporal lobe: a functional magnetic resonance imaging study. Hippocampus. 1997;7(6):594–601. doi: 10.1002/(SICI)1098-1063(1997)7:6<594::AID-HIPO2>3.0.CO;2-F. [DOI] [PubMed] [Google Scholar]
  29. Royce G. J., Mourey R. J. Efferent connections of the centromedian and parafascicular thalamic nuclei: an autoradiographic investigation in the cat. J Comp Neurol. 1985 May 15;235(3):277–300. doi: 10.1002/cne.902350302. [DOI] [PubMed] [Google Scholar]
  30. SCOVILLE W. B., MILNER B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry. 1957 Feb;20(1):11–21. doi: 10.1136/jnnp.20.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Sandson T. A., Daffner K. R., Carvalho P. A., Mesulam M. M. Frontal lobe dysfunction following infarction of the left-sided medial thalamus. Arch Neurol. 1991 Dec;48(12):1300–1303. doi: 10.1001/archneur.1991.00530240106031. [DOI] [PubMed] [Google Scholar]
  32. Savage L. M., Sweet A. J., Castillo R., Langlais P. J. The effects of lesions to thalamic lateral internal medullary lamina and posterior nuclei on learning, memory and habituation in the rat. Behav Brain Res. 1997 Jan;82(2):133–147. doi: 10.1016/s0166-4328(97)80983-7. [DOI] [PubMed] [Google Scholar]
  33. Shallice T. Specific impairments of planning. Philos Trans R Soc Lond B Biol Sci. 1982 Jun 25;298(1089):199–209. doi: 10.1098/rstb.1982.0082. [DOI] [PubMed] [Google Scholar]
  34. Shuren J. E., Jacobs D. H., Heilman K. M. Diencephalic temporal order amnesia. J Neurol Neurosurg Psychiatry. 1997 Feb;62(2):163–168. doi: 10.1136/jnnp.62.2.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Speedie L. J., Heilman K. M. Anterograde memory deficits for visuospatial material after infarction of the right thalamus. Arch Neurol. 1983 Mar;40(3):183–186. doi: 10.1001/archneur.1983.04050030077017. [DOI] [PubMed] [Google Scholar]
  36. Squire L. R., Amaral D. G., Zola-Morgan S., Kritchevsky M., Press G. Description of brain injury in the amnesic patient N.A. based on magnetic resonance imaging. Exp Neurol. 1989 Jul;105(1):23–35. doi: 10.1016/0014-4886(89)90168-4. [DOI] [PubMed] [Google Scholar]
  37. Takamatsu K., Yamamoto M., Yamano T., Ohno F. A case of amnestic syndrome due to right thalamic infarction. Jpn J Med. 1990 May-Jun;29(3):301–304. doi: 10.2169/internalmedicine1962.29.301. [DOI] [PubMed] [Google Scholar]
  38. Young H. L., Stevens A. A., Converse E., Mair R. G. A comparison of temporal decay in place memory tasks in rats (Rattus norvegicus) with lesions affecting thalamus, frontal cortex, or the hippocampal system. Behav Neurosci. 1996 Dec;110(6):1244–1260. doi: 10.1037//0735-7044.110.6.1244. [DOI] [PubMed] [Google Scholar]
  39. Zola-Morgan S., Squire L. R., Amaral D. G. Human amnesia and the medial temporal region: enduring memory impairment following a bilateral lesion limited to field CA1 of the hippocampus. J Neurosci. 1986 Oct;6(10):2950–2967. doi: 10.1523/JNEUROSCI.06-10-02950.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Zola-Morgan S., Squire L. R. Neuroanatomy of memory. Annu Rev Neurosci. 1993;16:547–563. doi: 10.1146/annurev.ne.16.030193.002555. [DOI] [PubMed] [Google Scholar]
  41. von Cramon D. Y., Hebel N., Schuri U. A contribution to the anatomical basis of thalamic amnesia. Brain. 1985 Dec;108(Pt 4):993–1008. doi: 10.1093/brain/108.4.993. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES