RESIDENT & FELLOW SECTION Section Editor John J. Millichap, MD Maria Jose Bruzzone, MD Rick Gill, MD Sean Ruland, DO Teaching NeuroImages: Aphasia after infarction of the left pulvinar nucleus Figure Axial sections of brain MRI Correspondence to Dr. Bruzzone: mariajose.bruzzonegiraldez@ uchospitals.edu Confluent area of restricted diffusion (A) in the left occipital lobe with extension to the left pulvinar nucleus with apparent diffusion coefficient correlation (B). A 79-year-old man, admitted for left knee replacement, complained of right-sided vision loss on postoperative day 3. Examination revealed a right homonymous hemianopsia, fluent speech with semantic paraphasias, and impaired naming and comprehension, with intact repetition. MRI of the brain (figure) showed restricted diffusion affecting the left pulvinar nucleus, without signal abnormality in the cortical language areas. Isolated posterior thalamic territory infarctions are rare, which may be explained by the dual blood supply of this nucleus, with contributions from the anterior circulation (anterior choroidal artery) and posterior circulation through several branches.1–3 The typical symptoms of thalamic aphasia consist of fluent output, semantic paraphasias, impairment of comprehension, and normal repetition. The relationship among the thalamus, language function, and aphasia is complex and has recently been reviewed by Llano3 and Crosson.4 AUTHOR CONTRIBUTIONS Dr. Bruzzone: acquisition of data, analysis and interpretation, manuscript redaction. Dr. Gill: acquisition of data, analysis and interpretation. Dr. Ruland: study supervision, revision of the manuscript. STUDY FUNDING No targeted funding reported. DISCLOSURE The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures. REFERENCES 1. Morandi X, Brassier G, Darnault P, et al. Microsurgical anatomy of the anterior choroidal artery. Surg Radiol Anat 1996; 18:275–280. 2. Takahashi S, Suzuki M, Matsumoto K, et al. Extent and location of cerebral infarcts on multiplanar MR images: correlation with distribution of perforating arteries on cerebral angiograms and on cadaveric microangiograms. AJR Am J Roentgenol 1994;163:1215– 1222. 3. Llano DA. Functional imaging of the thalamus in language. Brain Lang 2013;126:62–72. 4. Crosson B. Thalamic mechanisms in language: a reconsideration based on recent findings and concepts. Brain Lang 2013;126:73–88. Download teaching slides: Neurology.org From the Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL. e82 © 2016 American Academy of Neurology ª 2016 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. Teaching NeuroImages: Aphasia after infarction of the left pulvinar nucleus Maria Jose Bruzzone, Rick Gill and Sean Ruland Neurology 2016;87;e82 DOI 10.1212/WNL.0000000000003003 This information is current as of August 22, 2016 Updated Information & Services including high resolution figures, can be found at: http://www.neurology.org/content/87/8/e82.full.html Supplementary Material Supplementary material can be found at: http://www.neurology.org/content/suppl/2016/08/20/WNL.000000000 0003003.DC1.html References This article cites 4 articles, 0 of which you can access for free at: http://www.neurology.org/content/87/8/e82.full.html##ref-list-1 Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Infarction http://www.neurology.org//cgi/collection/infarction MRI http://www.neurology.org//cgi/collection/mri Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions Reprints Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2016 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.