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Fluctuating cognitive dysfunction due to intracranial steal phenomenon
302
Abstracts / Journal of the Neurological Sciences 283 (2009) 240–320
concerned with mood regulation and socially appropriate behavior, and of the dorsolateral prefrontal loop which mediates executive cognitive functions. doi:10.1016/j.jns.2009.02.234
onset and long standing unconsciousness and they may have long-term permanent cognitive deficits mostly on memory, attention, visiospatial and executive function. Although they can improve partially, they are not able to return to their former social and professional activities. doi:10.1016/j.jns.2009.02.236
Strategic infarction dementia mimicking sudden cognitive and behavioral change induced by glubus pallidus infarction Fluctuating cognitive dysfunction due to intracranial steal phenomenon K.H. Park, Y.B. Lee, S.H. Kim, D.J. Shin, H.M. Park Department of Neurology, Gachon University, Gil Medical Center, Incheon, South Korea Background and aims: There have been many reports showing the striatum may play an integrative role in cognitive information processing in motor as well as in non-motor tasks. Nevertheless, recently there has been increasing interest in the non-motor functions of globus pallidus especially in their roles in cognitive processing. We report a case presenting behavioral and cognitive dysfunction after focal left globus pallidus infarction. Case: A 71-year old right handed man presented with abnormal behavior that occurred about 3 days before admission. Examination revealed mild disorientation, inattention, apathy, amnesia, decreased verbal fluency and emotional blunting without any alterations to consciousness. There was no past history of psychiatric illness or alcohol and drug abuse. A brain magnetic resonance imaging showed high signal in left basal ganglia especially left globus pallidus on T2 and diffusion weighted image. Neuropsychological assessment that was performed 7 days after admission revealed decreased frontal executive function with mild bilateral parieto-temporal dysfunction. After a 2 week period, he showed gradual improvement in recent memory disturbance and apathy, but sustained some cognitive deficits including inattention and decreased verbal fluency. Conclusions: There are a few reports of globus pallidus lesion affects on cognitive and behavior change, in which mentioned that disruption of interconnected frontal-subcortical circuit, the limbic-striatal-pallidal-thalamic and the limbic-thalamo-cortial circuits leads to cognitive impairment. This case suggests that strategic infarction dementia can possibly be developed by a single globus pallidus lesion. doi:10.1016/j.jns.2009.02.235
Follow-up of two cases with bilateral simultaneous thalamic infarcts clinically and cognitively G. Kenangil, D. Necioğlu Örken, Z. Mail, H. Forta, M. Celik Department of Neurology, ŞIşLi Etfal Education and Research Hospital, Istanbul, Turkey Background and aims: Simultaneous bilateral paramedian thalamic infarctions (BPTI) are rare and have been recognized as a cause of acute unconsciousness and cognitive deterioration. We present 2 cases of bilateral paramedian thalamic infarction evaluated at 6 months after stroke, and describe the acute and long-term neuropsychological effects and the prognosis of BPTI. Methods: The selection of tests aimed to measure different aspects of language, orientation, memory (15 word test), attention (digit span), visiospatial (spontaneous drawing of a cube and a clock) and executive functioning (verbal category fluency and Luria test). Nonetheless patients have been evaluated with MMSE after gaining consciousness in acute period and in at the sixth month. Results: Both cases were admitted to the hospital with a sudden onset of unconsciousness, with a Glasgow Coma Scale of 9 and 11 respectively. Pupillary responses were normal, ocular axes were skewed in the vertical plane and had vertical gaze palsy. They had no motor paresis. Their MMSE at the first month were 9/30 and 10/30 respectively. Diffusion-weighted (DW1) images revealed bilateral hyper signals on paramedian thalamic regions with decreased signals on apparent diffusion coefficient (ADC) consistent with an acute infarction. At month 6, they were disoriented, had attention and visiospatial deficits. They performed normally on the immediate recall, but had impairment in long and short-term memory. Verbal fluency was reduced. They scored 19/30 and 18/30 on mini mental state examination respectively. Conclusion: Prognosis in BPTI’s are variable, while some patients remain severely disabled some of them was reported to recover completely. As with the two cases reported here, patients with BPTI might present with sudden
S. Junga, I.S. Kohb, S.H. Hwanga, J.H. Shina, K.H. Kwona, K.H. Yua, S.B. Kwona a Department of Neurology, Hallym University College of Medicine, Seoul, South Korea b Department of Neurology, National Medical Center, Seoul, South Korea Background: Although most cases of intracranial AVM present with neurologic symptoms and signs associated with their mass effects, uncommon neurologic manifestations associated with hemodynamic change can be possible independent of mass effect. Case: A 62-year-old man was admitted to the neurological department due to right hemiparesthesia. Neurologic exam revealed bilateral altitudinal pattern of visual field defect and fluctuanion of memory dysfunction in addition to paresthesia. MMSE-K showed fluctuation which varied from 24 points (of 30 points) to 12 points. MRI and MRA showed pial AVM of right PICA and acute infarction on right occipitotemoral gyrus and bilateral thalamus. Comment: We report a rare case of intracranial steal phenomenon with fluctuation of cognitive function in patient with pial AVM. doi:10.1016/j.jns.2009.02.237
Cognitive assessment batteries for patients with mild vascular cognitive impairment J.P. Jia, A.H. Zhou The Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China Background and aims: To develop a comprehensive and a screening neuropsychological battery for mild vascular cognitive impairment (mVCI). Methods: Eighty mVCI patients (mVCI with subcortical small vessel disease, mVCI-SSVD, n = 56; mVCI with multi-infarct or strategic infarct, mVCI-MI/SI, n = 24) were recruited. Extended neuropsychological tests covering six cognitive domains were administered to these patients and to 80 normal controls. The predicting ability of each domain and individual test to detect mVCI and its subgroups was explored. From four cognitive domains, six most discriminating single tests were selected to form a comprehensive battery. Four short-time tests were chosen for a screening battery. The sensitivity and specificity of these two batteries in detecting mVCI and its subtypes from normal controls were determined. Results: MVCI and its subtype groups had impairments in multiple domains. Memory assessment showed the highest predictive ability in diagnosis of mVCI and its subgroups. The comprehensive and the screening batteries achieved good sensitivity and specificity in differentiating mVCI, mVCI-SSVD, and mVCIMI/SI patients from normal controls (comprehensive battery: sensitivity 91.3% to 96.4%, specificity 97.5% to 98.8%; screening battery: sensitivity 79.2% to 87.5%, specificity 91.3% to 96.3%). Similarly high discriminant validity was obtained in subjects with MMSE scores of 28 or above. The batteries were equally effective in subjects who differed in age, education, and gender. Conclusions: The comprehensive battery and the screening battery showed good discrimination in differentiating mVCI and its subgroups from normal controls. Both batteries might be potentially useful in assessing mVCI in clinical work. doi:10.1016/j.jns.2009.02.238
Executive functions and peculiarities in stroke patients M.T. Janelidze, N.N. Lobjanidze, N.G. Mikava Department of Neurology, Tbilisi State Medical University, Tbilisi, Georgia
Abstracts / Journal of the Neurological Sciences 283 (2009) 240–320
concerned with mood regulation and socially appropriate behavior, and of the dorsolateral prefrontal loop which mediates executive cognitive functions. doi:10.1016/j.jns.2009.02.234
onset and long standing unconsciousness and they may have long-term permanent cognitive deficits mostly on memory, attention, visiospatial and executive function. Although they can improve partially, they are not able to return to their former social and professional activities. doi:10.1016/j.jns.2009.02.236
Strategic infarction dementia mimicking sudden cognitive and behavioral change induced by glubus pallidus infarction Fluctuating cognitive dysfunction due to intracranial steal phenomenon K.H. Park, Y.B. Lee, S.H. Kim, D.J. Shin, H.M. Park Department of Neurology, Gachon University, Gil Medical Center, Incheon, South Korea Background and aims: There have been many reports showing the striatum may play an integrative role in cognitive information processing in motor as well as in non-motor tasks. Nevertheless, recently there has been increasing interest in the non-motor functions of globus pallidus especially in their roles in cognitive processing. We report a case presenting behavioral and cognitive dysfunction after focal left globus pallidus infarction. Case: A 71-year old right handed man presented with abnormal behavior that occurred about 3 days before admission. Examination revealed mild disorientation, inattention, apathy, amnesia, decreased verbal fluency and emotional blunting without any alterations to consciousness. There was no past history of psychiatric illness or alcohol and drug abuse. A brain magnetic resonance imaging showed high signal in left basal ganglia especially left globus pallidus on T2 and diffusion weighted image. Neuropsychological assessment that was performed 7 days after admission revealed decreased frontal executive function with mild bilateral parieto-temporal dysfunction. After a 2 week period, he showed gradual improvement in recent memory disturbance and apathy, but sustained some cognitive deficits including inattention and decreased verbal fluency. Conclusions: There are a few reports of globus pallidus lesion affects on cognitive and behavior change, in which mentioned that disruption of interconnected frontal-subcortical circuit, the limbic-striatal-pallidal-thalamic and the limbic-thalamo-cortial circuits leads to cognitive impairment. This case suggests that strategic infarction dementia can possibly be developed by a single globus pallidus lesion. doi:10.1016/j.jns.2009.02.235
Follow-up of two cases with bilateral simultaneous thalamic infarcts clinically and cognitively G. Kenangil, D. Necioğlu Örken, Z. Mail, H. Forta, M. Celik Department of Neurology, ŞIşLi Etfal Education and Research Hospital, Istanbul, Turkey Background and aims: Simultaneous bilateral paramedian thalamic infarctions (BPTI) are rare and have been recognized as a cause of acute unconsciousness and cognitive deterioration. We present 2 cases of bilateral paramedian thalamic infarction evaluated at 6 months after stroke, and describe the acute and long-term neuropsychological effects and the prognosis of BPTI. Methods: The selection of tests aimed to measure different aspects of language, orientation, memory (15 word test), attention (digit span), visiospatial (spontaneous drawing of a cube and a clock) and executive functioning (verbal category fluency and Luria test). Nonetheless patients have been evaluated with MMSE after gaining consciousness in acute period and in at the sixth month. Results: Both cases were admitted to the hospital with a sudden onset of unconsciousness, with a Glasgow Coma Scale of 9 and 11 respectively. Pupillary responses were normal, ocular axes were skewed in the vertical plane and had vertical gaze palsy. They had no motor paresis. Their MMSE at the first month were 9/30 and 10/30 respectively. Diffusion-weighted (DW1) images revealed bilateral hyper signals on paramedian thalamic regions with decreased signals on apparent diffusion coefficient (ADC) consistent with an acute infarction. At month 6, they were disoriented, had attention and visiospatial deficits. They performed normally on the immediate recall, but had impairment in long and short-term memory. Verbal fluency was reduced. They scored 19/30 and 18/30 on mini mental state examination respectively. Conclusion: Prognosis in BPTI’s are variable, while some patients remain severely disabled some of them was reported to recover completely. As with the two cases reported here, patients with BPTI might present with sudden
S. Junga, I.S. Kohb, S.H. Hwanga, J.H. Shina, K.H. Kwona, K.H. Yua, S.B. Kwona a Department of Neurology, Hallym University College of Medicine, Seoul, South Korea b Department of Neurology, National Medical Center, Seoul, South Korea Background: Although most cases of intracranial AVM present with neurologic symptoms and signs associated with their mass effects, uncommon neurologic manifestations associated with hemodynamic change can be possible independent of mass effect. Case: A 62-year-old man was admitted to the neurological department due to right hemiparesthesia. Neurologic exam revealed bilateral altitudinal pattern of visual field defect and fluctuanion of memory dysfunction in addition to paresthesia. MMSE-K showed fluctuation which varied from 24 points (of 30 points) to 12 points. MRI and MRA showed pial AVM of right PICA and acute infarction on right occipitotemoral gyrus and bilateral thalamus. Comment: We report a rare case of intracranial steal phenomenon with fluctuation of cognitive function in patient with pial AVM. doi:10.1016/j.jns.2009.02.237
Cognitive assessment batteries for patients with mild vascular cognitive impairment J.P. Jia, A.H. Zhou The Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China Background and aims: To develop a comprehensive and a screening neuropsychological battery for mild vascular cognitive impairment (mVCI). Methods: Eighty mVCI patients (mVCI with subcortical small vessel disease, mVCI-SSVD, n = 56; mVCI with multi-infarct or strategic infarct, mVCI-MI/SI, n = 24) were recruited. Extended neuropsychological tests covering six cognitive domains were administered to these patients and to 80 normal controls. The predicting ability of each domain and individual test to detect mVCI and its subgroups was explored. From four cognitive domains, six most discriminating single tests were selected to form a comprehensive battery. Four short-time tests were chosen for a screening battery. The sensitivity and specificity of these two batteries in detecting mVCI and its subtypes from normal controls were determined. Results: MVCI and its subtype groups had impairments in multiple domains. Memory assessment showed the highest predictive ability in diagnosis of mVCI and its subgroups. The comprehensive and the screening batteries achieved good sensitivity and specificity in differentiating mVCI, mVCI-SSVD, and mVCIMI/SI patients from normal controls (comprehensive battery: sensitivity 91.3% to 96.4%, specificity 97.5% to 98.8%; screening battery: sensitivity 79.2% to 87.5%, specificity 91.3% to 96.3%). Similarly high discriminant validity was obtained in subjects with MMSE scores of 28 or above. The batteries were equally effective in subjects who differed in age, education, and gender. Conclusions: The comprehensive battery and the screening battery showed good discrimination in differentiating mVCI and its subgroups from normal controls. Both batteries might be potentially useful in assessing mVCI in clinical work. doi:10.1016/j.jns.2009.02.238
Executive functions and peculiarities in stroke patients M.T. Janelidze, N.N. Lobjanidze, N.G. Mikava Department of Neurology, Tbilisi State Medical University, Tbilisi, Georgia