From the Guidelines
You may expect to find aphasia in a patient with a hypertensive left thalamic hemorrhagic CVA, as aphasia is a common consequence of stroke, particularly with left hemispheric strokes. According to the Canadian Stroke Best Practice Recommendations, update 2015, aphasia is defined as a disorder of language resulting in the loss of ability to communicate orally, through signs, or in writing, or the inability to understand such communications 1. Although the study notes that aphasia is almost exclusively seen with left hemispheric strokes, thalamic aphasia can occur when the hemorrhage disrupts the thalamic nuclei involved in language processing or extends to affect adjacent language pathways.
The specific type of aphasia typically seen with left thalamic lesions is fluent aphasia with preserved comprehension but impaired word-finding abilities and possible semantic paraphasias. Key characteristics of aphasia in such patients include:
- Impaired language processing
- Disrupted communication abilities
- Potential for improvement over time with resolution of the acute hemorrhage and surrounding edema
- Need for comprehensive language assessment, examining naming, repetition, comprehension, reading, and writing abilities
When evaluating such patients, it is essential to perform a comprehensive language assessment and initiate speech-language therapy early as part of the rehabilitation process, as aggressive management of aphasia through therapy helps to improve both language and broader recovery 1. The presence of aphasia in thalamic hemorrhage occurs because the thalamus serves as a relay station for multiple cortical networks, including those involved in language processing, and damage to these circuits can disrupt language function even without direct cortical injury.
From the Research
Expectation of Aphasia in a Patient with Hypertensive Left Thalamic Haemorrhagic CVA
- The presence of aphasia in patients with left thalamic hemorrhage is supported by studies, with one study indicating that 51% of patients with left thalamic lesions had aphasia 2.
- Another study found that patients with left-sided posterolateral thalamic hemorrhage had primarily transcortical aphasia 3.
- The clinical features of thalamic hemorrhage, including aphasia, can vary depending on the location and size of the hemorrhage, as well as the presence of other risk factors such as hypertension 2, 3, 4.
- A case study reported a patient with left thalamic hypertensive haemorrhage presenting as transient global amnesia, highlighting the potential for thalamic hemorrhage to present with a range of cognitive and linguistic deficits 5.
- While the studies do not provide a direct correlation between hypertensive left thalamic haemorrhagic CVA and aphasia, they suggest that aphasia is a possible outcome in patients with left thalamic lesions, particularly those with posterolateral or medial hemorrhages 2, 3.