With the widespread use of computerized tomography (CT), it has become evident that aphasia and other cortical syndromes can result from lesions limited to subcortical structures. Both single-photon emission computed tomography (SPECT) and positron emission tomography (PET) have shown that subcortical strokes are accompanied by important abnormalities of cortical metabolism and perfusion. Strokes in the basal ganglia and deep white matter tracts can produce disorders of oral and written language, apraxia, neglect, amnesia, apathy, and several other psychiatric disturbances. Multiple subcortical lacunar stroke and vascular white matter changes are associated with cognitive impairment, cognitive decline, depression, and dementia. Posterior hematomas, including the pulvinar and dorsal nuclei, are those most commonly associated with aphasia, because this is the only region of the thalamus connected with cortical language areas. Most of these subcortical lesions were located in the right hemisphere, indicating that right subcortical structures are dominant for hemispatial attention and intention.