OBJECTIVE The thalamus is the integrative hub of the brain with reciprocal connections throughout the cortex. This case report describes a right-handed 81-year-old male patient who experienced sudden onset cognitive impairment following a focal left anterior thalamic infarct. METHODS With consent/assent, the patient was seen for a short neuropsychological assessment 6 weeks post stroke. Neuropsychological assessment included review of medical history, collateral intake, the Toronto Cognitive Assessment, Frontal Systems Behavior Scale-Family Rating Form, the Neuropsychiatric Inventory Questionnaire, and piano performance. RESULTS The assessment revealed impaired performance on measures of orientation, memory, executive function, and language, as well as symptoms including hallucinations, apathy, and hypersomnolence, consistent with thalamic dementia. Remarkably, in this context, the patient maintained an ability to play piano and read music. CONCLUSIONS The case has implications for understanding the complex integrative functions of the thalamus, including how profound impairment can simultaneously present with cognitive strengths that may not be captured by performance on neuropsychological testing. This case also suggests that magnetic resonance imaging may be indicated in cases presenting with vascular risk factors and sudden onset cognitive impairment, given that computed tomography may not be sensitive to small subcortical infarcts.

中文翻译：

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钢琴人：丘脑前部梗塞伴痴呆和保留音乐能力的病例报告。

目的 丘脑是大脑的综合枢纽，与整个皮质相互连接。本病例报告描述了一名 81 岁右利手男性患者，在局灶性左丘脑前部梗塞后突然出现认知障碍。方法 经同意/同意，患者在中风后 6 周接受简短的神经心理学评估。神经心理学评估包括回顾病史、附带摄入量、多伦多认知评估、额叶系统行为量表-家庭评级表、神经精神问卷调查和钢琴演奏。结果评估显示方向、记忆、执行功能和语言方面的表现受损，以及包括幻觉、冷漠和嗜睡在内的症状，与丘脑痴呆一致。值得注意的是，在这种情况下，患者保持了弹钢琴和阅读音乐的能力。结论 该病例对于理解丘脑复杂的整合功能具有重要意义，包括深度损伤如何与神经心理学测试表现可能无法捕获的认知优势同时出现。该病例还表明，鉴于计算机断层扫描可能对小型皮质下梗死不敏感，因此在存在血管危险因素和突然发生的认知障碍的病例中可能需要进行磁共振成像。