title: Thalamic thought disorder: on being "a bit addled".
abstract: Humans can generate and maintain relatively coherent trains of thought in natural discourse. The neural mediation of this ability and the phenomenology of its breakdown are not well understood. We report a case of a woman with paramedian thalamic strokes involving the mammillothalamic tract, intralaminar nuclei, parts of the dorsomedial and ventral lateral nuclei bilaterally. She presented with a dense amnesia and confusion typical of the syndrome of bilateral paramedian thalamic infarcts. Her Tc-99m HMPAO brain SPECT scan showed decreased thalamic and basal ganglia blood flow. General diminution of cerebral blood flow and areas of further diminution in the right frontal, left temporal and left temporoparietal regions were also observed. Although her amnesia was characteristic of diencephalic amnesia, her most striking clinical feature was a bizarre, disconnected and at times incoherent speech output. Analysis of her speech revealed relatively preserved lexical and morpho-syntactic linguistic production. By contrast, analysis of the macrostructure of her discourse revealed frequent unpredictable topic shifts that were completely unconstrained by contextual factors. Many of her shifts were intrusions from previous topics. We interpret her severely disordered speech output as representing the surface manifestations of a thought disorder (rather than as a language disorder per se) characterized by an inability to maintain and appropriately shift themes that normally guide discourse. Median and intralaminar thalamic nuclei appear to be critical for the neurophysiologic regulation of thalamocortical and striatocortical circuits, which in turn may be critical for the functional regulation of contextually appropriate transitions of thought.
authors.affiliation: Department of Neurology, University of Alabama in Birmingham, USA.
authors.forename: A
authors.initials: A
authors.lastname: Chatterjee
authors.forename: R
authors.initials: R
authors.lastname: Yapundich
authors.forename: M
authors.initials: M
authors.lastname: Mennemeier
authors.forename: J M
authors.initials: JM
authors.lastname: Mountz
authors.forename: C
authors.initials: C
authors.lastname: Inampudi
authors.forename: J W
authors.initials: JW
authors.lastname: Pan
authors.forename: G W
authors.initials: GW
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D001288:Attention / Q000502:physiology; D001479:Basal Ganglia / Q000098:blood supply; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000098:blood supply; D002544:Cerebral Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D003221:Confusion / Q000503:physiopathology / Q000523:psychology; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D009483:Neuropsychological Tests; D012039:Regional Blood Flow / Q000502:physiology; D013786:Thalamic Diseases / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D013787:Thalamic Nuclei / Q000098:blood supply*; D013850:Thinking / Q000502:physiology*; D015899:Tomography, Emission-Computed, Single-Photon; D014705:Verbal Behavior / Q000502:physiology