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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Nov;71(5):658–662. doi: 10.1136/jnnp.71.5.658

Extensive metabolic and neuropsychological abnormalities associated with discrete infarction of the genu of the internal capsule

F Chukwudelunzu 1, J Meschia 1, N Graff-Radford 1, J Lucas 1
PMCID: PMC1737596  PMID: 11606679

Abstract

OBJECTIVE—The clinical presentation of capsular genu infarct varies. Prominent faciolingual weakness and subcortical dementia are the rule, but symptoms depend on the precise location and extension of the lesion beyond the genu. The aim was to characterise the radiographic, electroencephalographic, and neuropsychometric abnormalities in a woman who had a history of recurrent transient memory loss.
METHOD—Case report.
RESULTS—Magnetic resonance imaging showed an infarct in the genu of the left internal capsule. Positron emission tomography scan demonstrated decreased metabolic activity in the ipsilateral temporal, occipitotemporal, and contralateral cerebellar hemispheres. Electroencephalography showed intermittent rhythmic delta activity in the left frontotemporal region, and findings on neuropsychometric evaluation were consistent with cognitive impairment. Follow up evaluation 7 months after the stroke showed improvement in some areas of the cognitive domain, but residual neuropsychometric and neurophysiological abnormalities persisted.
CONCLUSION—This case illustrates that cerebral and cerebellar diaschisis may contribute to the symptomatic presentation and recovery from capsular genu infarct, although its precise role remains elusive.



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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andrews R. J. Transhemispheric diaschisis. A review and comment. Stroke. 1991 Jul;22(7):943–949. doi: 10.1161/01.str.22.7.943. [DOI] [PubMed] [Google Scholar]
  2. Baron J. C., D'Antona R., Pantano P., Serdaru M., Samson Y., Bousser M. G. Effects of thalamic stroke on energy metabolism of the cerebral cortex. A positron tomography study in man. Brain. 1986 Dec;109(Pt 6):1243–1259. doi: 10.1093/brain/109.6.1243. [DOI] [PubMed] [Google Scholar]
  3. Bogousslavsky J., Regli F., Assal G. The syndrome of unilateral tuberothalamic artery territory infarction. Stroke. 1986 May-Jun;17(3):434–441. doi: 10.1161/01.str.17.3.434. [DOI] [PubMed] [Google Scholar]
  4. Bogousslavsky J., Regli F. Capsular genu syndrome. Neurology. 1990 Oct;40(10):1499–1502. doi: 10.1212/wnl.40.10.1499. [DOI] [PubMed] [Google Scholar]
  5. Bowler J. V., Wade J. P., Jones B. E., Nijran K., Jewkes R. F., Cuming R., Steiner T. J. Contribution of diaschisis to the clinical deficit in human cerebral infarction. Stroke. 1995 Jun;26(6):1000–1006. doi: 10.1161/01.str.26.6.1000. [DOI] [PubMed] [Google Scholar]
  6. Donnan G. A., Bladin P. F., Berkovic S. F., Longley W. A., Saling M. M. The stroke syndrome of striatocapsular infarction. Brain. 1991 Feb;114(Pt 1A):51–70. [PubMed] [Google Scholar]
  7. Dunker R. O., Harris A. B. Surgical anatomy of the proximal anterior cerebral artery. J Neurosurg. 1976 Mar;44(3):359–367. doi: 10.3171/jns.1976.44.3.0359. [DOI] [PubMed] [Google Scholar]
  8. Feeney D. M., Baron J. C. Diaschisis. Stroke. 1986 Sep-Oct;17(5):817–830. doi: 10.1161/01.str.17.5.817. [DOI] [PubMed] [Google Scholar]
  9. Ghika J. A., Bogousslavsky J., Regli F. Deep perforators from the carotid system. Template of the vascular territories. Arch Neurol. 1990 Oct;47(10):1097–1100. doi: 10.1001/archneur.1990.00530100063014. [DOI] [PubMed] [Google Scholar]
  10. Ghika J., Bogousslavsky J., Regli F. Infarcts in the territory of the deep perforators from the carotid system. Neurology. 1989 Apr;39(4):507–512. doi: 10.1212/wnl.39.4.507. [DOI] [PubMed] [Google Scholar]
  11. Graff-Radford N. R., Eslinger P. J., Damasio A. R., Yamada T. Nonhemorrhagic infarction of the thalamus: behavioral, anatomic, and physiologic correlates. Neurology. 1984 Jan;34(1):14–23. doi: 10.1212/wnl.34.1.14. [DOI] [PubMed] [Google Scholar]
  12. Graff-Radford N. R., Tranel D., Van Hoesen G. W., Brandt J. P. Diencephalic amnesia. Brain. 1990 Feb;113(Pt 1):1–25. doi: 10.1093/brain/113.1.1. [DOI] [PubMed] [Google Scholar]
  13. Guberman A., Stuss D. The syndrome of bilateral paramedian thalamic infarction. Neurology. 1983 May;33(5):540–546. doi: 10.1212/wnl.33.5.540. [DOI] [PubMed] [Google Scholar]
  14. Hodges J. R., Warlow C. P. The aetiology of transient global amnesia. A case-control study of 114 cases with prospective follow-up. Brain. 1990 Jun;113(Pt 3):639–657. doi: 10.1093/brain/113.3.639. [DOI] [PubMed] [Google Scholar]
  15. Hénon H., Pasquier F., Durieu I., Godefroy O., Lucas C., Lebert F., Leys D. Preexisting dementia in stroke patients. Baseline frequency, associated factors, and outcome. Stroke. 1997 Dec;28(12):2429–2436. doi: 10.1161/01.str.28.12.2429. [DOI] [PubMed] [Google Scholar]
  16. Infeld B., Davis S. M., Lichtenstein M., Mitchell P. J., Hopper J. L. Crossed cerebellar diaschisis and brain recovery after stroke. Stroke. 1995 Jan;26(1):90–95. doi: 10.1161/01.str.26.1.90. [DOI] [PubMed] [Google Scholar]
  17. Irle E., Markowitsch H. J. Connections of the hippocampal formation, mamillary bodies, anterior thalamus and cingulate cortex. A retrograde study using horseradish peroxidase in the cat. Exp Brain Res. 1982;47(1):79–94. doi: 10.1007/BF00235889. [DOI] [PubMed] [Google Scholar]
  18. Iwata M. Unilateral palatal paralysis caused by lesion in the corticobulbar tract. Arch Neurol. 1984 Jul;41(7):782–784. doi: 10.1001/archneur.1984.04050180104029. [DOI] [PubMed] [Google Scholar]
  19. Karbe H., Herholz K., Szelies B., Pawlik G., Wienhard K., Heiss W. D. Regional metabolic correlates of Token test results in cortical and subcortical left hemispheric infarction. Neurology. 1989 Aug;39(8):1083–1088. doi: 10.1212/wnl.39.8.1083. [DOI] [PubMed] [Google Scholar]
  20. Kashihara M., Matsumoto K. Acute capsular infarction. Location of the lesions and the clinical features. Neuroradiology. 1985;27(3):248–253. doi: 10.1007/BF00344496. [DOI] [PubMed] [Google Scholar]
  21. Kooistra C. A., Heilman K. M. Memory loss from a subcortical white matter infarct. J Neurol Neurosurg Psychiatry. 1988 Jun;51(6):866–869. doi: 10.1136/jnnp.51.6.866. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kushner M., Alavi A., Reivich M., Dann R., Burke A., Robinson G. Contralateral cerebellar hypometabolism following cerebral insult: a positron emission tomographic study. Ann Neurol. 1984 May;15(5):425–434. doi: 10.1002/ana.410150505. [DOI] [PubMed] [Google Scholar]
  23. Lai C., Okada Y., Sadoshima S., Saku Y., Kuwabara Y., Fujishima M. [A case of left internal capsular infarction with auditory hallucination and peculiar amnesia and dysgraphia]. No To Shinkei. 1990 Sep;42(9):873–877. [PubMed] [Google Scholar]
  24. Markowitsch H. J., von Cramon D. Y., Hofmann E., Sick C. D., Kinzler P. Verbal memory deterioration after unilateral infarct of the internal capsule in an adolescent. Cortex. 1990 Dec;26(4):597–609. doi: 10.1016/s0010-9452(13)80309-7. [DOI] [PubMed] [Google Scholar]
  25. Meneghetti G., Vorstrup S., Mickey B., Lindewald H., Lassen N. A. Crossed cerebellar diaschisis in ischemic stroke: a study of regional cerebral blood flow by 133Xe inhalation and single photon emission computerized tomography. J Cereb Blood Flow Metab. 1984 Jun;4(2):235–240. doi: 10.1038/jcbfm.1984.32. [DOI] [PubMed] [Google Scholar]
  26. Metter E. J., Wasterlain C. G., Kuhl D. E., Hanson W. R., Phelps M. E. FDG positron emission computed tomography in a study of aphasia. Ann Neurol. 1981 Aug;10(2):173–183. doi: 10.1002/ana.410100208. [DOI] [PubMed] [Google Scholar]
  27. Miura H., Nagata K., Hirata Y., Satoh Y., Watahiki Y., Hatazawa J. Evolution of crossed cerebellar diaschisis in middle cerebral artery infarction. J Neuroimaging. 1994 Apr;4(2):91–96. doi: 10.1111/jon19944291. [DOI] [PubMed] [Google Scholar]
  28. Moreaud O., Charnallet A., David D., Cinotti L., Pellat J. Frontal lobe syndrome after a left genu capsular infarction. Eur Neurol. 1996;36(5):322–324. [PubMed] [Google Scholar]
  29. Pantano P., Baron J. C., Samson Y., Bousser M. G., Derouesne C., Comar D. Crossed cerebellar diaschisis. Further studies. Brain. 1986 Aug;109(Pt 4):677–694. doi: 10.1093/brain/109.4.677. [DOI] [PubMed] [Google Scholar]
  30. Pantano P., Lenzi G. L., Guidetti B., Di Piero V., Gerundini P., Savi A. R., Fazio F., Fieschi C. Crossed cerebellar diaschisis in patients with cerebral ischemia assessed by SPECT and 123I-HIPDM. Eur Neurol. 1987;27(3):142–148. doi: 10.1159/000116147. [DOI] [PubMed] [Google Scholar]
  31. Pantoni L., Garcia J. H. The significance of cerebral white matter abnormalities 100 years after Binswanger's report. A review. Stroke. 1995 Jul;26(7):1293–1301. doi: 10.1161/01.str.26.7.1293. [DOI] [PubMed] [Google Scholar]
  32. Pappata S., Mazoyer B., Tran Dinh S., Cambon H., Levasseur M., Baron J. C. Effects of capsular or thalamic stroke on metabolism in the cortex and cerebellum: a positron tomography study. Stroke. 1990 Apr;21(4):519–524. doi: 10.1161/01.str.21.4.519. [DOI] [PubMed] [Google Scholar]
  33. Pappata S., Tran Dinh S., Baron J. C., Cambon H., Syrota A. Remote metabolic effects of cerebrovascular lesions: magnetic resonance and positron tomography imaging. Neuroradiology. 1987;29(1):1–6. doi: 10.1007/BF00341027. [DOI] [PubMed] [Google Scholar]
  34. Perani D., Di Piero V., Lucignani G., Gilardi M. C., Pantano P., Rossetti C., Pozzilli C., Gerundini P., Fazio F., Lenzi G. L. Remote effects of subcortical cerebrovascular lesions: a SPECT cerebral perfusion study. J Cereb Blood Flow Metab. 1988 Aug;8(4):560–567. doi: 10.1038/jcbfm.1988.97. [DOI] [PubMed] [Google Scholar]
  35. Perani D., Vallar G., Cappa S., Messa C., Fazio F. Aphasia and neglect after subcortical stroke. A clinical/cerebral perfusion correlation study. Brain. 1987 Oct;110(Pt 5):1211–1229. doi: 10.1093/brain/110.5.1211. [DOI] [PubMed] [Google Scholar]
  36. Robertson R. T., Kaitz S. S. Thalamic connections with limbic cortex. I. Thalamocortical projections. J Comp Neurol. 1981 Jan 20;195(3):501–525. doi: 10.1002/cne.901950308. [DOI] [PubMed] [Google Scholar]
  37. Rousseaux M., Lesoin F., Quint S. Unilateral pseudobulbar syndrome with limited capsulothalamic infarction. Eur Neurol. 1987;27(4):227–230. doi: 10.1159/000116161. [DOI] [PubMed] [Google Scholar]
  38. Schnider A., Gutbrod K., Hess C. W., Schroth G. Memory without context: amnesia with confabulations after infarction of the right capsular genu. J Neurol Neurosurg Psychiatry. 1996 Aug;61(2):186–193. doi: 10.1136/jnnp.61.2.186. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Spertell R. B., Ransom B. R. Dysarthria--clumsy hand syndrome produced by capsular infarct. Ann Neurol. 1979 Sep;6(3):263–265. doi: 10.1002/ana.410060315. [DOI] [PubMed] [Google Scholar]
  40. Tatemichi T. K., Desmond D. W., Prohovnik I., Cross D. T., Gropen T. I., Mohr J. P., Stern Y. Confusion and memory loss from capsular genu infarction: a thalamocortical disconnection syndrome? Neurology. 1992 Oct;42(10):1966–1979. doi: 10.1212/wnl.42.10.1966. [DOI] [PubMed] [Google Scholar]
  41. Terao Y., Bandou M., Nagura H., Yamanouchi H., Ishikawa T. [Persistent amnestic syndrome due to infarction of the genu of the left internal capsule]. Rinsho Shinkeigaku. 1991 Sep;31(9):1002–1006. [PubMed] [Google Scholar]
  42. Welsh K. A., Butters N., Mohs R. C., Beekly D., Edland S., Fillenbaum G., Heyman A. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology. 1994 Apr;44(4):609–614. doi: 10.1212/wnl.44.4.609. [DOI] [PubMed] [Google Scholar]
  43. Yamadori A. [Does circumscribed ischemic white matter lesion produce neuropsychological symptoms?]. Rinsho Shinkeigaku. 1990 Dec;30(12):1348–1350. [PubMed] [Google Scholar]
  44. Yamanaka K., Fukuyama H., Kimura J. Abulia from unilateral capsular genu infarction: report of two cases. J Neurol Sci. 1996 Nov;143(1-2):181–184. doi: 10.1016/s0022-510x(96)00201-8. [DOI] [PubMed] [Google Scholar]
  45. Yesavage J. A., Brink T. L., Rose T. L., Lum O., Huang V., Adey M., Leirer V. O. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37–49. doi: 10.1016/0022-3956(82)90033-4. [DOI] [PubMed] [Google Scholar]
  46. Zeman A. Z., Boniface S. J., Hodges J. R. Transient epileptic amnesia: a description of the clinical and neuropsychological features in 10 cases and a review of the literature. J Neurol Neurosurg Psychiatry. 1998 Apr;64(4):435–443. doi: 10.1136/jnnp.64.4.435. [DOI] [PMC free article] [PubMed] [Google Scholar]

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