To report an unusual presentation of right-sided thalamic infarction causing mixed-aphasia.

Traditional teaching stresses on the fact that aphasia is a cortical finding usually originating from the dominant left cerebral hemisphere. However, in rare scenarios aphasia could arise from right sided subcortical lesions, especially from the thalamus and basal ganglia when the right hemisphere is language dominant. Herein, we discuss a patient with mixed aphasia from right-sided, subcortical thalamic stroke.

A case report.

An 87-year-old, left-handed male without significant prior medical history, presented with agitation, bilateral ataxia, profound hemi-visual and sensory neglect, and mixed aphasia with significant comprehensive component and predominant semantic-verbal paraphasia. To exemplify, he was unable to state where he was, the month or the year and referred to the phone as “a campus”; When asked on how a pen is used, he answered: “To keep up with things” and had impaired repetition. He was unable to name a camel but could state that “It lives in Egypt”. CT Angiography revealed a right posterior cerebral artery occlusion within the P2 segment and MRI brain revealed an acute ischemic stroke in right thalamus along with small lesions in the infratentorial regions. He significantly improved over the course of admission and only had mild ataxia at the time of discharge.

The biggest challenge that this case posed was the aphasic presentation in the setting of a right subcortical thalamic lesion. We hypothesized that his language dominance and thereby his aphasia could be localized to his deep right cerebral hemisphere. Although aphasia is usually a cortical finding from the dominant left hemisphere, unusual presentations with right sided subcortical lesions as seen in our patient should always be considered.