“Thalamic aphasia” after stroke is associated with left anterior lesion location



Aphasic symptoms are typically associated with lesions of the left fronto-temporal cortex. Interestingly, aphasic symptoms have also been described in patients with thalamic strokes in anterior, paramedian or posterolateral location. So far, systematic analyses are missing.


We conducted a retrospective analysis of consecutive patients admitted to our tertiary stroke care center between January 2016 and July 2017 with image-based (MRI) proven ischemic stroke. We evaluated stroke lesion location, using 3-T MRI, and presence of aphasic symptoms.


Out of 1064 patients, 104 (9.8%) presented with a thalamic stroke, 52 of which (4.9%) had an isolated lesion in the thalamus (ILT). In patients with ILT, 6/52 had aphasic symptoms. Aphasic symptoms after ILT were only present in patients with left anterior lesion location (n = 6, 100% left anterior vs. 0% other thalamic location, p < 0.001).


Aphasic symptoms in thalamic stroke are strongly associated with left anterior lesion location. In thalamo-cortical language networks, specifically the nuclei in the left anterior thalamus could play an important role in integration of left cortical information with disconnection leading to aphasic symptoms.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Wernicke C (1874) Der aphasische Symptomenkomplex. Cohn and Weigert, Breslau

    Google Scholar 

  2. 2.

    Broca PP (1861) Remarque sur le siège de la faculté du language articulé, suivies d’une observation d’aphémie. Bull Soc Anatom Paris 6:330–357

    Google Scholar 

  3. 3.

    Llano DA (2015) Chapter 9—the thalamus and language. In: Hickok G, Small SL (eds) Neurobiology of language. Academic Press, London, pp 95–114. https://doi.org/10.1016/c2011-0-07351-9

    Google Scholar 

  4. 4.

    Murdoch BE (2001) Subcortical brain mechanisms in speech and language. Folia Phoniatr Logop 53(5):233–251. https://doi.org/10.1159/000052679

    Article  PubMed  CAS  Google Scholar 

  5. 5.

    Wallesch CW, Papagno C (1988) Subcortical aphasia. In: Rose FC, Whurr R, Wyke MA (eds) Aphasia. Whurr Publishers, London, pp 257–287

    Google Scholar 

  6. 6.

    Steriade M, Jones EG, Llinas RR (1990) Thalamic oscillations and signaling. The Neurosciences Institute publications series. Wiley, New York

    Google Scholar 

  7. 7.

    Nadeau SE, Crosson B (1997) Subcortical aphasia. Brain Lang 58(3):355–402. https://doi.org/10.1006/brln.1997.1707(discussion 418–323)

    Article  PubMed  CAS  Google Scholar 

  8. 8.

    Klostermann F, Krugel LK, Ehlen F (2013) Functional roles of the thalamus for language capacities. Front Syst Neurosci 7:32. https://doi.org/10.3389/fnsys.2013.00032

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Schmahmann JD (2003) Vascular syndromes of the thalamus. Stroke 34(9):2264–2278. https://doi.org/10.1161/01.STR.0000087786.38997.9E

    Article  PubMed  Google Scholar 

  10. 10.

    De Witte L, Brouns R, Kavadias D, Engelborghs S, De Deyn PP, Marien P (2011) Cognitive, affective and behavioural disturbances following vascular thalamic lesions: a review. Cortex 47(3):273–319. https://doi.org/10.1016/j.cortex.2010.09.002

    Article  PubMed  Google Scholar 

  11. 11.

    Cappa SF, Papagno C, Vallar G, Vignolo LA (1986) Aphasia does not always follow left thalamic hemorrhage: a study of five negative cases. Cortex 22(4):639–647

    Article  CAS  Google Scholar 

  12. 12.

    Bogousslavsky J, Miklossy J, Deruaz JP, Regli F (1988) Thalamic aphasia. Neurology 38(10):1662

    Article  CAS  Google Scholar 

  13. 13.

    Alexander MP, LoVerme SR Jr (1980) Aphasia after left hemispheric intracerebral hemorrhage. Neurology 30(11):1193–1202

    Article  CAS  Google Scholar 

  14. 14.

    Lhermitte F (1984) Language disorders and their relationship to thalamic lesions. Adv Neurol 42:99–113

    PubMed  CAS  Google Scholar 

  15. 15.

    Ford AA, Triplett W, Sudhyadhom A, Gullett J, McGregor K, Fitzgerald DB, Mareci T, White K, Crosson B (2013) Broca’s area and its striatal and thalamic connections: a diffusion-MRI tractography study. Front Neuroanat 7:8. https://doi.org/10.3389/fnana.2013.00008

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Kraut MA, Kremen S, Moo LR, Segal JB, Calhoun V, Hart J Jr (2002) Object activation in semantic memory from visual multimodal feature input. J Cogn Neurosci 14(1):37–47. https://doi.org/10.1162/089892902317205302

    Article  PubMed  Google Scholar 

  17. 17.

    Hotter B, Pittl S, Ebinger M, Oepen G, Jegzentis K, Kudo K, Rozanski M, Schmidt WU, Brunecker P, Xu C, Martus P, Endres M, Jungehulsing GJ, Villringer A, Fiebach JB (2009) Prospective study on the mismatch concept in acute stroke patients within the first 24 h after symptom onset—1000 plus study. BMC Neurol 9:60. https://doi.org/10.1186/1471-2377-9-60

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Carrera E, Bogousslavsky J (2006) The thalamus and behavior: effects of anatomically distinct strokes. Neurology 66(12):1817–1823. https://doi.org/10.1212/01.wnl.0000219679.95223.4c

    Article  PubMed  Google Scholar 

  19. 19.

    Kalbe E, Reinhold N, Brand M, Markowitsch HJ, Kessler J (2005) A new test battery to assess aphasic disturbances and associated cognitive dysfunctions—German normative data on the aphasia check list. J Clin Exp Neuropsychol 27(7):779–794. https://doi.org/10.1080/13803390490918273

    Article  PubMed  Google Scholar 

  20. 20.

    Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20(7):864–870

    Article  CAS  Google Scholar 

  21. 21.

    Gorelick PB, Hier DB, Benevento L, Levitt S, Tan W (1984) Aphasia after left thalamic infarction. Arch Neurol 41(12):1296–1298

    Article  CAS  Google Scholar 

  22. 22.

    Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S (2007) Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 369(9558):293–298. https://doi.org/10.1016/S0140-6736(07)60151-2

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Lim-Hing K, Rincon F (2017) Secondary hematoma expansion and perihemorrhagic edema after intracerebral hemorrhage: from bench work to practical aspects. Front Neurol 8:74. https://doi.org/10.3389/fneur.2017.00074

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Ehlen F, Schoenecker T, Kuhn AA, Klostermann F (2014) Differential effects of deep brain stimulation on verbal fluency. Brain Lang 134:23–33. https://doi.org/10.1016/j.bandl.2014.04.002

    Article  PubMed  Google Scholar 

  25. 25.

    Wahl M, Marzinzik F, Friederici AD, Hahne A, Kupsch A, Schneider GH, Saddy D, Curio G, Klostermann F (2008) The human thalamus processes syntactic and semantic language violations. Neuron 59(5):695–707. https://doi.org/10.1016/j.neuron.2008.07.011

    Article  PubMed  CAS  Google Scholar 

  26. 26.

    Kuncel AM, Cooper SE, Grill WM (2008) A method to estimate the spatial extent of activation in thalamic deep brain stimulation. Clin Neurophysiol 119(9):2148–2158. https://doi.org/10.1016/j.clinph.2008.02.025

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Crosson B (2013) Thalamic mechanisms in language: a reconsideration based on recent findings and concepts. Brain Lang 126(1):73–88. https://doi.org/10.1016/j.bandl.2012.06.011

    Article  PubMed  Google Scholar 

  28. 28.

    Saur D, Kreher BW, Schnell S, Kummerer D, Kellmeyer P, Vry MS, Umarova R, Musso M, Glauche V, Abel S, Huber W, Rijntjes M, Hennig J, Weiller C (2008) Ventral and dorsal pathways for language. Proc Natl Acad Sci USA 105(46):18035–18040. https://doi.org/10.1073/pnas.0805234105

    Article  PubMed  Google Scholar 

  29. 29.

    Kummerer D, Hartwigsen G, Kellmeyer P, Glauche V, Mader I, Kloppel S, Suchan J, Karnath HO, Weiller C, Saur D (2013) Damage to ventral and dorsal language pathways in acute aphasia. Brain 136(Pt 2):619–629. https://doi.org/10.1093/brain/aws354

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Yakovlev PI, Locke S (1961) Limbic nuclei of thalamus and connections of limbic cortex. III. Corticocortical connections of the anterior cingulate gyrus, the cingulum, and the subcallosal bundle in monkey. Arch Neurol 5:364–400

    Article  CAS  Google Scholar 

  31. 31.

    Vogt BA, Pandya DN, Rosene DL (1987) Cingulate cortex of the rhesus monkey: I. Cytoarchitecture and thalamic afferents. J Comp Neurol 262(2):256–270. https://doi.org/10.1002/cne.902620207

    Article  PubMed  CAS  Google Scholar 

  32. 32.

    Ojemann GA (1982) Models of the brain organization for higher integrative functions derived with electrical stimulation techniques. Hum Neurobiol 1(4):243–249

    PubMed  CAS  Google Scholar 

  33. 33.

    McCormick DA, Bal T (1997) Sleep and arousal: thalamocortical mechanisms. Annu Rev Neurosci 20:185–215. https://doi.org/10.1146/annurev.neuro.20.1.185

    Article  PubMed  CAS  Google Scholar 

  34. 34.

    Alain C, Reinke K, McDonald KL, Chau W, Tam F, Pacurar A, Graham S (2005) Left thalamo-cortical network implicated in successful speech separation and identification. Neuroimage 26(2):592–599. https://doi.org/10.1016/j.neuroimage.2005.02.006

    Article  PubMed  Google Scholar 

  35. 35.

    Assaf M, Calhoun VD, Kuzu CH, Kraut MA, Rivkin PR, Hart J Jr, Pearlson GD (2006) Neural correlates of the object-recall process in semantic memory. Psychiatry Res 147(2–3):115–126. https://doi.org/10.1016/j.pscychresns.2006.01.002

    Article  PubMed  Google Scholar 

  36. 36.

    Hillis AE, Barker PB, Wityk RJ, Aldrich EM, Restrepo L, Breese EL, Work M (2004) Variability in subcortical aphasia is due to variable sites of cortical hypoperfusion. Brain Lang 89(3):524–530. https://doi.org/10.1016/j.bandl.2004.01.007

    Article  PubMed  Google Scholar 

  37. 37.

    Sebastian R, Schein MG, Davis C, Gomez Y, Newhart M, Oishi K, Hillis AE (2014) Aphasia or neglect after thalamic stroke: the various ways they may be related to cortical hypoperfusion. Front Neurol 5:231. https://doi.org/10.3389/fneur.2014.00231

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Stenset V, Grambaite R, Reinvang I, Hessen E, Cappelen T, Bjornerud A, Gjerstad L, Fladby T (2007) Diaschisis after thalamic stroke: a comparison of metabolic and structural changes in a patient with amnesic syndrome. Acta Neurol Scand Suppl 187:68–71. https://doi.org/10.1111/j.1600-0404.2007.00851.x

    Article  PubMed  CAS  Google Scholar 

  39. 39.

    Baron JC, Levasseur M, Mazoyer B, Legault-Demare F, Mauguiere F, Pappata S, Jedynak P, Derome P, Cambier J, Tran-Dinh S et al (1992) Thalamocortical diaschisis: positron emission tomography in humans. J Neurol Neurosurg Psychiatry 55(10):935–942

    Article  CAS  Google Scholar 

  40. 40.

    Khalil AA, Ostwaldt AC, Nierhaus T, Ganeshan R, Audebert HJ, Villringer K, Villringer A, Fiebach JB (2017) Relationship between changes in the temporal dynamics of the blood-oxygen-level-dependent signal and hypoperfusion in acute ischemic stroke. Stroke 48(4):925–931. https://doi.org/10.1161/STROKEAHA.116.015566

    Article  PubMed  CAS  Google Scholar 

  41. 41.

    Brierley JB, Beck E (1959) The significance in human stereotactic brain surgery of individual variation in the diencephalon and globus pallidus. J Neurol Neurosurg Psychiatry 22:287–298

    Article  CAS  Google Scholar 

  42. 42.

    Krause T, Brunecker P, Pittl S, Taskin B, Laubisch D, Winter B, Lentza ME, Malzahn U, Villringer K, Villringer A, Jungehulsing GJ (2012) Thalamic sensory strokes with and without pain: differences in lesion patterns in the ventral posterior thalamus. J Neurol Neurosurg Psychiatry 83(8):776–784. https://doi.org/10.1136/jnnp-2011-301936

    Article  PubMed  Google Scholar 

Download references

Author information




All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MF, CN and MI. The first draft of the manuscript was written by MF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Merve Fritsch.

Ethics declarations

Conflicts of interest

Dr. Villringer reports Grants from Center of Stroke Research Berlin funded by the German Ministry of Education and Research, during the conduct of the study. In addition, Dr. Villringer has a patent European Patent application 17179320.01-1906 pending. Dr. Fritsch, Manuela Ihrke, Dr. Klostermann, Dr. Krause and Dr. Nolte have nothing to disclose.

Ethical standards

In accordance with laws and regulations in the Federal State of Berlin, this retrospective study did not require an ethics committee approval (§25 Berliner Krankenhausgesetz).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fritsch, M., Krause, T., Klostermann, F. et al. “Thalamic aphasia” after stroke is associated with left anterior lesion location. J Neurol 267, 106–112 (2020). https://doi.org/10.1007/s00415-019-09560-1

Download citation


  • Aphasia
  • Ischemic stroke
  • Lesion
  • Language network
  • Thalamus