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Thalamic alexia with agraphia

Fábio Henrique de Gobbi Porto, Maria Isabel d’Ávila Freitas, Maira Okada de Oliveira, Leandro Tavares Lucato, Marco Orsini, Sara Lúcia Silveira de Menezes, Regina Miksian Magaldi, Cláudia Sellitto Porto, Sonia Maria Dozzi Brucki, Ricardo Nitrini

Authors information
  • Fábio Henrique de Gobbi Porto
    Behavioral and Cognitive Neurology Unit, Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), São Paulo, Brazil.
  • Maria Isabel d’Ávila Freitas
    Behavioral and Cognitive Neurology Unit, Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), São Paulo, Brazil.
  • Maira Okada de Oliveira
    Behavioral and Cognitive Neurology Unit, Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), São Paulo, Brazil.
  • Leandro Tavares Lucato
    Department of Radiology, Clinical Hospital of University of São Paulo, São Paulo, Brazil.
  • Marco Orsini
    Neurology Department, Fluminense Federal University and Masters Program in Science Rehabilitation, UNISUAM, Rio de Janeiro, Brazil. orsinimarco@hotmail.com
  • Sara Lúcia Silveira de Menezes
    Masters Program in Science Rehabilitation, UNISUAM, Rio de Janeiro, Brazil.
  • Regina Miksian Magaldi
    Memory and Aging Unit, Geriatric Service, Department of Clinical Medicine and Cognitive Disorders Reference Center, University of São Paulo School of Medicine, São Paulo, Brazil.
  • Cláudia Sellitto Porto
    Behavioral and Cognitive Neurology Unit, Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), São Paulo, Brazil.
  • Sonia Maria Dozzi Brucki
    Behavioral and Cognitive Neurology Unit, Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), São Paulo, Brazil.
  • Ricardo Nitrini
    Behavioral and Cognitive Neurology Unit, Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), São Paulo, Brazil.

Abstract


Alexia with agraphia is defined as an acquired impairment affecting reading and writing ability. It can be associated with aphasia, but can also occur as an isolated entity. This impairment has classically been associated with a left angular gyrus lesion In the present study, we describe a case involving a patient who developed alexia with agraphia and other cognitive deficits after a thalamic hemorrhage. In addition, we discuss potential mechanisms of this cortical dysfunction syndrome caused by subcortical injury. We examined a patient who presented with alexia with agraphia and other cognitive deficits due to a hemorrhage in the left thalamus. Neuropsychological evaluation showed attention, executive function, arithmetic and memory impairments. In addition, language tests revealed severe alexia with agraphia in the absence of aphasia. Imaging studies disclosed an old thalamic hemorrhage involving the anterior, dorsomedial and pulvinar nuclei. Tractography revealed asymmetric thalamocortical radiations in the parietal region (left - right), and single photon emission computed tomography demonstrated hypoperfusion in the left thalamus that extended to the frontal and parietal cortices. Cortical cognitive deficits, including alexia with agraphia, may occur as the result of thalamic lesions. The probable mechanism is a diaschisis phenomenon involving thalamic tract disconnections.

Keywords


agraphia with alexia, thalamic lesion, diaschisis phenomenon, tract disconnection

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Submitted: 2011-11-13 20:13:46
Published: 2012-02-09 16:20:45
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