Disrupted auto-activation, dysexecutive and confabulating syndrome following bilateral thalamic and right putaminal stroke.
OBJECTIVE
Clinical, neuropsychological, structural and functional neuroimaging results are reported in a patient who developed a unique combination of symptoms after a bi-thalamic and right putaminal stroke. The symptoms consisted of dysexecutive disturbances associated with confabulating behavior and auto-activation deficits.


BACKGROUND
Basal ganglia and thalamic lesions may result in a variety of motor, sensory, neuropsychological and behavioral syndromes. However, the combination of a dysexecutive syndrome complicated at the behavioral level with an auto-activation and confabulatory syndrome has never been reported.


METHODS
Besides clinical and neuroradiological investigations, an extensive set of standardized neuropsychological tests was carried out.


RESULTS
In the post-acute phase of the stroke, a dysexecutive syndrome was found in association with confabulating behavior and auto-activation deficits. MRI showed focal destruction of both thalami and the right putamen. Quantified ECD SPECT revealed bilateral hypoperfusions in the basal ganglia and thalamus but no perfusion deficits were found at the cortical level.


CONCLUSIONS
The combination of disrupted auto-activation, dysexecutive and confabulating syndrome in a single patient following isolated subcortical damage renders this case exceptional. Although these findings do not reveal a functional disruption of the striato-ventral pallidal-thalamic-frontomesial limbic circuitry, they add to the understanding of the functional role of the basal ganglia in cognitive and behavioral syndromes.
De Witte
Lieve
L
Department of Linguistics, Vrije Universiteit Brussel, Brussels, Belgium.
Engelborghs
Sebastiaan
S
Verhoeven
Jo
J
De Deyn
Peter P
PP
Mariën
Peter
P
D000342:Affective Symptoms / Q000209:etiology / Q000473:pathology; D000368:Aged; D001526:Behavioral Symptoms / Q000209:etiology / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology / Q000523:psychology*; D008192:Deception; D003702:Delusions / Q000209:etiology / Q000473:pathology* / Q000523:psychology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D009042:Motivation; D011699:Putamen / Q000473:pathology*; D012649:Self Concept; D020521:Stroke / Q000150:complications / Q000473:pathology* / Q000523:psychology; D013788:Thalamus / Q000473:pathology*