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Behavioural Neurology
Volume 19, Issue 4, Pages 177-194
http://dx.doi.org/10.1155/2008/905187

Crossed Aphasia and Visuo-Spatial Neglect Following a Right Thalamic Stroke: A Case Study and Review of the Literature

Lieve De Witte,1 Jo Verhoeven,1,3 Sebastiaan Engelborghs,4,5,6,7 Peter P. De Deyn,4,5,6,7 and Peter Mariën1,3,4,5

1Department of Linguistics, Vrije Universtiteit Brussel, Brussel, Belgium
2Department of Communication Sciences, City University, London, UK
3Institute of Behavioural Neuroscience, Antwerp, Belgium
4Department of Neurology and Memory Clinic, Middelheim General Hospital (ZNA), Antwerp, Belgium
5Laboratory of Neurochemistry and Behavior, Institute Born-Bunge Foundation, University of Antwerp, Antwerp, Belgium
6Department of Health Care Sciences, University College Antwerp, Antwerp, Belgium
7Department of Nursing Sciences, Faculty of Medicine, University of Antwerp, Antwerp, Belgium

Received 16 December 2008; Accepted 16 December 2008

Copyright © 2008 Hindawi Publishing Corporation and the authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Crossed aphasia in dextrals (CAD) following pure subcortical lesions is rare. This study describes a right-handed patient with an ischemic lesion in the right thalamus. In the post-acute phase of the stroke, a unique combination of ‘crossed thalamic aphasia’ was found with left visuo-spatial neglect and constructional apraxia. On the basis of the criteria used in Mariën et al. [67], this case-report is the first reliable representative of vascular CAD following an isolated lesion in the right thalamus. Furthermore, this paper presents a detailed analysis of linguistic and cognitive impairments of ‘possible’ and 'reliable' subcortical CAD-cases published since 1975. Out of 25 patients with a pure subcortical lesion, nine cases were considered as ‘possibly reliable or reliable’. A review of these cases reveals that: (1) demographic data are consistent with the general findings for the entire group of vascular CAD, (2) the neurolinguistic findings do not support the data in the general CAD-population with regard to (a) the high prevalence of transcortical aphasia and (b) the tendency towards a copresence of an oral versus written language dissociation and a ‘mirror-image’ lesion-aphasia profile, (3) subcortical CAD is not a transient phenomenon, (4) the lesion-aphasia correlations are not congruent with the high incidence of anomalous cases in the general CAD-population, (5) neuropsychological impairments may accompany subcortical CAD.