Description des troubles langagiers suite à un accident vasculaire cérébral ischémique du thalamus : une revue de la littérature.
DOI :
https://doi.org/10.61989/3b7y2c58Mots-clés :
thalamus, aphasie, troubles du langage, AVC, ischémie, orthophonieRésumé
Contexte : Le thalamus est une structure cérébrale complexe ayant fait l’objet de nombreuses études scientifiques depuis sa découverte. Son implication dans les processus langagiers est actuellement reconnue par la communauté scientifique.
Objectifs : Les objectifs de cette étude sont de recenser les dernières avancées de la recherche afin de préciser les manifestations cliniques des aphasies retrouvées lors d’un AVC ischémique du thalamus, et permettre aux orthophonistes de les évaluer et les prendre en charge de manière spécifique.
Méthode : L'utilisation de la méthode PRISMA en quatre étapes, a permis de constituer une revue de la littérature et de recenser les articles les plus pertinents concernant le sujet d’étude.
Résultats : Au total, ce sont 10 articles qui ont intégré cette revue de la littérature. Différents tests, plus ou moins exhaustifs et spécifiques, ont été administrés aux échantillons de patients de ces études, afin d’évaluer les fonctions langagières. Cette revue recense et analyse des informations concernant la fréquence, la sévérité, la latéralité et les atteintes cognitivo-linguistiques retrouvées en fonction du territoire vasculaire atteint, ainsi que l’évolution des aphasies thalamiques. L’hypothèse de la responsabilité d’une déconnexion thalamo-corticale pour les troubles langagiers est également évoquée.
Discussion : Les résultats ont montré que le thalamus est impliqué dans des processus langagiers, avec une latéralisation à gauche. Son atteinte pourrait être associée à des phénomènes de diaschisis et de déconnexion thalamo-corticale et provoquerait des altérations de la production et de la compréhension du langage. Le degré de sévérité est plutôt léger, avec une atteinte particulière du langage élaboré, pouvant ainsi provoquer des difficultés de diagnostic lors de la phase aiguë. La fréquence de l’aphasie thalamique est de ce fait variable en fonction des études, et dépend de la spécificité de l’évaluation des troubles du langage.
Conclusion : Les atteintes langagières dans le cas d’un AVC thalamique se caractérisent essentiellement par des troubles de la fluence, une anomie et peu ou pas d’atteinte de la répétition, avec un bon pronostic d’évolution. Il semble nécessaire d’utiliser des outils sensibles, élaborés d’après les modèles cognitifs et neuropsychologiques du langage, proposant ainsi une évaluation fine de l’aphasie thalamique, et permettant d’envisager des pistes rééducatives spécifiques et adaptées.
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