Clinical Significance of Neuropsychological Findings in Acute Stroke

DOI Web Site

Bibliographic Information

Other Title
  • 脳卒中急性期と神経心理学
  • 脳卒中急性期と神経心理学 : 症候-病巣不一致時の考え方
  • ノウソッチュウ キュウセイキ ト シンケイ シンリガク : ショウコウ-ビョウソウ フイッチジ ノ カンガエカタ
  • ── 症候-病巣不一致時の考え方 ──

Search this article

Abstract

<p>Six cases with clinical-radiological discrepancy were presented. Patient 1 was presented with transcortical sensory aphasia and a recent infarct in the left medial temporal lobe. SPECT revealed the hypoperfusional lesion in the left temporal lobe and the temporo-parieto-occipital junction as a misery perfusion. Patient 2 was suffered from sudden hemiparesis and difficulty of naming and writing, however his recent infarct were limited in the left internal capsula. On SPECT, he had broad hypoperfusional lesions in the bilateral parietal lobes. It was suggested that the responsible diseases for his agraphia and anomia was Alzheimer dementia. At Patient 3’s first attack with fluent aphasia, the responsible lesion was unclear on MRI but demonstrated a high uptake in the left temporal lobe SPECT. At the second attack with left hemianopia, the responsible lesion revealed weakly hyperintense changes in the right temporal lobe on DWI, but had a high uptake on SPECT. These lesions were diagnosed as incomplete infarction. Patient 4 with past history of subcortical hematoma in the right temporal lobe and infarction in the left occipital lobe suffered visual agnosia. MRI disclosed no recent infarcts. He was diagnosed as non-convulsive status epileptics. He was administrated with diazepam, thereafter his agnosia was subsided soon. Patient 5 developed sudden Korsakoff syndrome. MRI revealed no recent lesions and electroencephalogram did not show any epileptic discharge. He was suspected to have hepatic encephalopathy, because the Fischer ratio was low. Abdominal echography and CT scan disclosed a thrombus in the portal vein. It was suggested that he developed hepatic encephalopathy due to portal-systemic circulation shunting secondary to portal vein thrombosis. Patient 6 was presented with Wernicke aphasia, however MRI revealed recent infarcts in the midbrain and right cerebellar hemisphere. On SPECT, he had broad hypoperfusional lesions in the left parieto-temporal lobes. It was suggested that his aphasia was caused by remote effects or disruption of repair system situated in the right cerebral lobe.</p><p> In the cases with clinical-radiological discrepancy we should discuss below five questions: 1. how their neurological findings can be explained by the other elemental deficits;2. how they have occults lesions with misery perfusion;3. how their overt lesions affect other areas as a remote effect; 4. how covert diseases exist;and finally 5. how novel clinic-anatomical relationship was investigated in their cases.</p>

Journal

Keywords

Details 詳細情報について

Report a problem

Back to top