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Scharf AC, Gronewold J, Eilers A, Todica O, Moenninghoff C, Doeppner TR, de Haan B, Bassetti CL, Hermann DM. Depression and anxiety in acute ischemic stroke involving the anterior but not paramedian or inferolateral thalamus. Front Psychol 2023; 14:1218526. [PMID: 37701875 PMCID: PMC10493383 DOI: 10.3389/fpsyg.2023.1218526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background and objectives Emotional and cognitive deficits are prevalent in strokes involving the thalamus. In contrast to cognitive deficits, emotional deficits have not been studied prospectively in isolated thalamic stroke. Methods In 37 ischemic thalamic stroke patients (57.0 [50.0; 69.5] years [median (Q1; Q3)], 21 males, 5 anterior, 12 paramedian, 20 inferolateral vascular territory), and 37 non-stroke control patients matched for age and sex, we prospectively examined depression, anxiety, activities of daily living, and quality of life at 1, 6, 12, and 24 months post-stroke using the Hospital-Anxiety-and-Depression Scale (HADS), Nürnberger-Alters-Alltagsaktivitäten scale (NAA), and Short Form-36 (SF36) questionnaire. Voxel-based lesion-symptom mapping (VLSM) and lesion-subtraction analyzes were performed to determine associations between questionnaire scores and thalamic stroke topography. Results At 1 month post-stroke, anterior thalamic stroke patients had higher depression scores [8.0 (7.5; 10.5)] than paramedian [4.5 (1.0; 5.8)] and inferolateral [4.0 (1.0; 7.0)] thalamic stroke patients. Furthermore, anterior thalamic stroke patients had higher anxiety scores [11.0 (8.0; 14.5)] than their matched controls [2.5 (2.0; 2.5)], paramedian [4.5 (1.0; 5.8)] and inferior [4.0 (1.0; 7.0)] thalamic stroke patients. Depression and anxiety scores in anterior thalamic stroke patients remained high across the follow-up [depression: 9.0 (3.5; 13,8); anxiety:10.05 (2.8, 14.5)].Physical health assessed by SF36 was intact in anterior [1 month post-stroke: T-score = 55.9 (37.0; 57.6)] but reduced in inferolateral [44.5(32.4; 53.1)] thalamic stroke, whereas mental health was reduced in anterior thalamic stroke [32.0 (29.8; 47.3)].VLSM confirmed that voxels in the anterior thalamus around Montreal Neurological Institute (MNI) coordinates X = -8, Y = -12, Z = 2 were more often affected by the stroke in depressed (HADS-score ≥ 8) than non-depressed (HADS-score < 8) patients and voxels around coordinates X = -10, Y = -12, Z = 2 were more often affected in anxious (HADS-score ≥ 8) than non-anxious (HADS-score < 8) patients. Conclusion Anterior, but not paramedian or inferolateral thalamic stroke was associated with depression and anxiety. Even though our results are mostly significant in the left thalamus, this observation on stroke laterality might be confounded by the fact that the right hemisphere was underrepresented in our study.
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Affiliation(s)
- Anne-Carina Scharf
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Janine Gronewold
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andres Eilers
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Olga Todica
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Moenninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thorsten R. Doeppner
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Bianca de Haan
- Division of Psychology, Department of Life Sciences, Centre for Cognitive Neuroscience, Brunel University, London, United Kingdom
| | | | - Dirk M. Hermann
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Fritsch M, Rangus I, Nolte CH. Thalamic Aphasia: a Review. Curr Neurol Neurosci Rep 2022; 22:855-865. [PMID: 36383308 PMCID: PMC9750901 DOI: 10.1007/s11910-022-01242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE OF REVIEW Thalamic aphasia is a rare language disorder resulting from lesions to the thalamus. While most patients exhibit mild symptoms with a predominance of lexical-semantic difficulties, variations in phenotype have been described. Overall, the exact mechanisms of thalamic aphasia await empirical research. The article reviews recent findings regarding phenotypes and possible underlying mechanisms of thalamic aphasia. RECENT FINDINGS Variations in phenotype of thalamic aphasia may be related to different lesion locations. Overall, the thalamus' role in language is thought to be due to its involvement in cortico-thalamic language networks with lesioning of certain nuclei resulting in the diachisis of otherwise interconnected areas. Its possible monitoring function in such a network might be due to its different cellular firing modes. However, no specific evidence has been collected to date. While recent findings show a more distinct understanding of thalamic aphasia phenotypes and possible underlying mechanisms, further research is needed. Additionally, as standard language testing might oftentimes not pick up on its subtle symptoms, thalamic aphasia might be underdiagnosed.
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Affiliation(s)
- Merve Fritsch
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Ida Rangus
- grid.6363.00000 0001 2218 4662Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H. Nolte
- grid.6363.00000 0001 2218 4662Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
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Fritsch M, Villringer K, Ganeshan R, Rangus I, Nolte CH. Frequency, clinical presentation and outcome of vigilance impairment in patients with uni- and bilateral ischemic infarction of the paramedian thalamus. J Neurol 2021; 268:4340-4348. [PMID: 33881597 PMCID: PMC8505279 DOI: 10.1007/s00415-021-10565-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/02/2022]
Abstract
Ischemic stroke of the paramedian thalamus is a rare differential diagnosis in sudden altered vigilance states. While efforts to describe clinical symptomatology exist, data on the frequency of paramedian thalamic stroke as a cause of sudden impaired vigilance and on accompanying clinical signs and outcome are scarce. We retrospectively analyzed consecutive patients admitted to a tertiary stroke center between 2010 and 2019 diagnosed with paramedian thalamic stroke. We evaluated frequency of vigilance impairment (VI) due to paramedian thalamic stroke, accompanying clinical signs and short-term outcome in uni- versus bilateral paramedian lesion location. Of 3896 ischemic stroke patients, 53 showed a paramedian thalamic stroke location (1.4%). VI was seen in 29/53 patients with paramedian thalamic stroke and in 414/3896 with any stroke (10.6%). Paramedian thalamic stroke was identified as causal to VI in 3.4% of all patients with initial VI in the emergency department and in 0.7% of all ischemic stroke patients treated in our center. Accompanying clinical signs were detected in 21 of these 29 patients (72.4%) and facilitated a timely diagnosis. VI was significantly more common after bilateral than unilateral lesions (92.0% vs. 21.4%; p < 0.001). Patients with bilateral paramedian lesions were more severely affected, had longer hospital stays and more frequently required in-patient rehabilitation. Paramedian thalamic lesions account for about 1 in 15 stroke patients presenting with impaired vigilance. Bilateral paramedian lesion location is associated with worse stroke severity and short-term outcome. Paying attention to accompanying clinical signs is of importance as they may facilitate a timely diagnosis.
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Affiliation(s)
- Merve Fritsch
- Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ramanan Ganeshan
- Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ida Rangus
- Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Ehlen F, Vonberg I, Kühn AA, Klostermann F. Effects of thalamic deep brain stimulation on spontaneous language production. Neuropsychologia 2016; 89:74-82. [PMID: 27267813 DOI: 10.1016/j.neuropsychologia.2016.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/18/2016] [Accepted: 05/25/2016] [Indexed: 12/31/2022]
Abstract
The thalamus is thought to contribute to language-related processing, but specifications of this notion remain vague. An assessment of potential effects of thalamic deep brain stimulation (DBS) on spontaneous language may help to delineate respective functions. For this purpose, we analyzed spontaneous language samples from thirteen (six female / seven male) patients with essential tremor treated with DBS of the thalamic ventral intermediate nucleus (VIM) in their respective ON vs. OFF conditions. Samples were obtained from semi-structured interviews and examined on multidimensional linguistic levels. In the VIM-DBS ON condition, participants used a significantly higher proportion of paratactic as opposed to hypotactic sentence structures. This increase correlated negatively with the change in the more global cognitive score, which in itself did not change significantly. In conclusion, VIM-DBS appears to induce the use of a simplified syntactic structure. The findings are discussed in relation to concepts of thalamic roles in language-related cognitive behavior.
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Affiliation(s)
- Felicitas Ehlen
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Neurology, Motor and Cognition Group, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Isabelle Vonberg
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Neurology, Motor and Cognition Group, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Andrea A Kühn
- Charité - University Medicine Berlin, Campus Virchow Klinikum, Department of Neurology, Motor Neuroscience Group, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Fabian Klostermann
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Neurology, Motor and Cognition Group, Hindenburgdamm 30, 12203 Berlin, Germany.
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Kraft A, Irlbacher K, Finke K, Kaufmann C, Kehrer S, Liebermann D, Bundesen C, Brandt SA. Dissociable spatial and non-spatial attentional deficits after circumscribed thalamic stroke. Cortex 2014; 64:327-42. [PMID: 25597524 DOI: 10.1016/j.cortex.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/25/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022]
Abstract
Thalamic nuclei act as sensory, motor and cognitive relays between multiple subcortical areas and the cerebral cortex. They play a crucial role in cognitive functions such as executive functioning, memory and attention. In the acute period after thalamic stroke attentional deficits are common. The precise functional relevance of specific nuclei or vascular sub regions of the thalamus for attentional sub functions is still unclear. The theory of visual attention (TVA) allows the measurement of four independent attentional parameters (visual short term memory storage capacity (VSTM), visual perceptual processing speed, selective control and spatial weighting). We combined parameter-based assessment based on TVA with lesion symptom mapping in standard stereotactic space in sixteen patients (mean age 41.2 ± 11.0 SD, 6 females), with focal thalamic lesions in the medial (N = 9), lateral (N = 5), anterior (N = 1) or posterior (N = 1) vascular territories of the thalamus. Compared with an age-matched control group of 52 subjects (mean age 40.1 ± 6.4, 35 females), the patients with thalamic lesions were, on the group level, mildly impaired in visual processing speed and VSTM. Patients with lateral thalamic lesions showed a deficit in processing speed while all other TVA parameters were within the normal range. Medial thalamic lesions can be associated with a spatial bias and extinction of targets either in the ipsilesional or the contralesional field. A posterior case with a thalamic lesion of the pulvinar replicated a finding of Habekost and Rostrup (2006), demonstrating a spatial bias to the ipsilesional field, as suggested by the neural theory of visual attention (NTVA) (Bundesen, Habekost, & Kyllingsbæk, 2011). A case with an anterior-medial thalamic lesion showed reduced selective attentional control. We conclude that lesions in distinct vascular sub regions of the thalamus are associated with distinct attentional syndromes (medial = spatial bias, lateral = processing speed).
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Affiliation(s)
- Antje Kraft
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Kerstin Irlbacher
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Finke
- Department of Psychology, General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Kaufmann
- Clinical Psychology, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie Kehrer
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniela Liebermann
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claus Bundesen
- Center of Visual Cognition, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Stephan A Brandt
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Klostermann F, Krugel LK, Ehlen F. Functional roles of the thalamus for language capacities. Front Syst Neurosci 2013; 7:32. [PMID: 23882191 PMCID: PMC3712252 DOI: 10.3389/fnsys.2013.00032] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/25/2013] [Indexed: 01/06/2023] Open
Abstract
Early biological concepts of language were predominantly corticocentric, but over the last decades biolinguistic research, equipped with new technical possibilities, has drastically changed this view. To date, connectionist models, conceiving linguistic skills as corticobasal network activities, dominate our understanding of the neural basis of language. However, beyond the notion of an involvement of the thalamus and, in most cases also, the basal ganglia (BG) in linguistic operations, specific functions of the respective depth structures mostly remain rather controversial. In this review, some of these issues shall be discussed, particularly the functional configuration of basal network components and the language specificity of subcortical supporting activity. Arguments will be provided for a primarily cortico-thalamic language network. In this view, the thalamus does not engage in proper linguistic operations, but rather acts as a central monitor for language-specific cortical activities, supported by the BG in both perceptual and productive language execution.
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Affiliation(s)
- Fabian Klostermann
- Department of Neurology, Motor and Cognition Group, Charité - University Medicine BerlinCBF, Berlin, Germany
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