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


METHODS
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.


CONCLUSIONS
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.
Chukwudelunzu
F E
FE
Department of Neurology, Luther-Midelfort Clinic, Eau Claire, Wisconsin, USA.
Meschia
J F
JF
Graff-Radford
N R
NR
Lucas
J A
JA
D000368:Aged; D002531:Cerebellum / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D003700:Delta Rhythm; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D009483:Neuropsychological Tests; D009778:Occipital Lobe / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology; D012008:Recurrence; D013702:Temporal Lobe / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology; D014055:Tomography, Emission-Computed