In particular, thalamic haemorrhage is known to cause cognitive dysfunctions

(e.g. aphasia and unilateral neglect) along with motor paralysis and sensory
impairment
Since the thalamus influences numerous functions
of both the subcortical and cortical regions, we
would also expect to see a high rate of dysphagia caused
by thalamic haemorrhage.
At the time of initial
BSA, 62 of 113 subjects (54.9%) had swallowing abnormalities
( table 1 ).
After thalamic haemorrhage, various neurologic manifestations
may be observed, including motor paralysis,
sensory impairment, ocular motility disorder, visual field
defects and ataxia. Therefore, thalamic haemorrhage has
a great impact on ADLs. However, no previous reports
were identified that focussed on the relationship between
the frequency of dysphagia caused by thalamic haemorrhage
and stroke focus, haematoma volume and functional
prognosis
dysphagia could appear after a lesion to any of
these levels. This study confirms that a high incidence of
dysphagia is seen in cases of thalamic haemorrhage and
that dysphagia is often accompanied by aphasia and unilateral
neglect. This suggests dysfunction in a wide range
of the cortex, potentially suggesting a link between thalamic
haemorrhage and eating and swallowing disorders
that could be triggered by subcortical nerve fibres.

Activation of the internal capsule

is an expected and important functional feature in
swallowing, as the internal capsule serves to functionally
connect cortical and brain stem nuclei via
the cortical bulbar tracts. Vascular injury to these
white matter tracts has been associated with oropharyngeal
deficits in swallowing (26). Activation
in the white matter, however, raises the issue of the
BOLD effect in the absence of synaptic activity,
since the white matter consists of axons.
the insular cortex is thought to
serve a variety of functions, including sensory and
motor integration between primary cortex and other
subcortical (thalamic) nuclei or limbic areas.
The nuclei of the thalamus are heterogeneous in
their functional roles, with some nuclei serving as
relays for cortical areas and others generally serving
as association areas (33, 34).
The globus pallidus
projects to the ventral anterior group of the
thalamus, which then projects to the primary motor

and supplementary motor cortices. The ventral posterior

group is primarily involved with somatosensory
integration, receiving input from the spinothalamic
and trigeminal tracts and projecting to the
primary somatosensory cortex. The pulvinar, as an
association nucleus, maintains reciprocal connections
to the temporal, parietal, and occipital lobes
for integration of sensory information and cognitive
and visual association functions. Activation of
thalamic nuclei during swallowing tasks indicates
the necessary role of sensory and motor input processing
via thalamocortical or thalamostriatal pathways
in swallowin

The primary
motor cortex sends motor output via efferent fibers to the
internal capsule through which the cortical-bulbar fibers
descend and transit through the cerebral peduncles to the
pontine and medullary n~c l e i .
The thalamus
is composed of six sets of nuclei subserving roles in
association (pulvinar, dorsal group), as relay nuclei (ventral
anterior and posterior groups), or nonspecific functions
(the intralaminar, midline, and reticular nuclei).
Both the ventral anterior group and the posterior group
maintain connections to other cortical and subcortical
sites that are important in sensory-motor i n t e g r a t i ~ n . ~ ~
The role of the thalamus during swallowing tasks then
may be important for sensory-motor integration through
thalamo-cortical or thalamo-striatial pathways.

Somatosensory deficit was identified in 21

patients (nine mild and 12 severe) and visual field defect
(hemianopsia in the contralateral space) in eight patients.
Five of the nine patients with left side lesion had
aphasia (three Wernicke, one Amnestic, one Total).
Kumral et a1.6 found that there were clinical differences
in lesions in different parts of the thalamus. They
concluded that posterolateral and anterolateral thalamic
haemorrhages lead to severe sensorimotor and neuropsychological
deficits, medial lesions lead to sensorimotor
deficits (and if the medial lesion is large enough,
neuropsychological deficits), and dorsal lesions lead to
mild and transient sensorimotor and neuropsychological
deficits.
trigeminal sensory nuclear complex and that this pattern
is relayed to the thalamus from certain regions of the
trigeminal nuclei.
For afferent inputs to contribute to perceptual

mechanisms they must terminate on neurons that project

this information to the thalamus where it is relayed again
to reach the cerebral cortex.
project to the thalamus.
Trigeminothalamic projections from the spinal trigeminal
nucleus are exclusively contralateral. Although the oral
cavity is represented throughout the rostrocaudal extent
of the nucleus, the number of thalamic projection neurons
varies from one region to another
Oral Cavity Representation in the
Ventrobasal Thalamus
The site for thalamic relay of most information traveling
in ascending somatosensory pathways is the ventrobasal nucleus which consists of the ventroposterolateral (VPL)

and ventoposteromedial (VPM) nucleus. Microelectrode

studies of the receptive fields of single and multiple units
in the ventrobasal thalamus confirm that most of the
information from the face and oral cavity terminates in
VPM [36

La cpsula interna es un conjunto de fibras que contiene gran parte de las fibras de
proyeccin desde la corteza cerebral a ncleos subcorticales y viceversa. Consta de un
brazo anterior, brazo posterior y rodilla.