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Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

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Agraphia caused by left thalamic hemorrhage.

Aiko Osawa¹, Shinichiro Maeshima, Fumitaka Yamane

¹Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Japan.

Case Reports in Neurology

|April 27, 2013

Summary

A stroke affecting the left thalamus caused agraphia, a writing disorder. Reduced blood flow in connected brain regions, not just the thalamus, likely explains the persistent writing deficits.

Keywords:

Agraphia Aphasia Cerebral hemorrhage Stroke

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Area of Science:

Neuroscience
Neurology
Stroke Research

Background:

Stroke can lead to various cognitive deficits, including aphasia and agraphia.
Thalamic lesions are known to cause neurological and cognitive impairments.
Understanding the precise mechanisms of post-stroke cognitive deficits is crucial for effective treatment.

Observation:

A 71-year-old male presented with right hemiparesis, sensory impairment, and mild aphasia following a stroke.
While aphasia resolved, the patient exhibited persistent agraphia.
Computed tomography (CT) revealed a left thalamic hematoma without cortical lesions.

Findings:

Single-photon emission computed tomography (SPECT) indicated reduced blood flow in the left thalamus.
SPECT also showed decreased perfusion in the left superior temporal gyrus, parietal lobe, and frontal lobe.
These findings suggest a widespread disruption of left cortical function and thalamocortical pathways.

Implications:

Agraphia may result from thalamic lesions, but also from associated disruptions in thalamocortical and cortico-thalamocortical fibers.
SPECT imaging is valuable in identifying the extent of functional deficits beyond the initial lesion site.
This case highlights the complex network interactions in the brain and their role in cognitive functions like writing.