Teaching NeuroImages: Aphasia after infarction of the left pulvinar nucleus

A 79-year-old man, admitted for left knee replacement, complained of right-sided vision loss on postoperative day 3. Examination revealed a right homonymous hemianopsia, fluent speech with semantic paraphasias, and impaired naming and comprehension, with intact repetition. MRI of the brain (figure) showed restricted diffusion affecting the left pulvinar nucleus, without signal abnormality in the cortical language areas.