Case of Left Thalamic Hemorrhage and Presumed Presence of Multimodal Agnosia

Abstract

We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.