title: Cognitive disconnective syndrome by single strategic strokes in vascular dementia.
abstract: Strategic regions correspond to associative, limbic and paralimbic structures and related circuits, that underpin cognitive/behavioral functions. Strokes in these eloquent sites produce pictures of vascular dementia with syndromic features due to specific site lesion and/or interruption of their interconnections. This study aims at analysing subcortical strategic strokes that express similar cognitive/behavioral elements, by sharing common pathways. Patients (n=6) who attended in specialized ambulatory, were submitted to neuropsychological and neuroimaging assessments through MRI (GE Signa Horizon 1.5T) and brain SPECT (Millennium MG, ECD [TC-99m]). Stroke locations and respective main symptoms were: 1. anteromedian thalamus [L]: anterograde and retrograde amnesia (ARA), expression aphasia (EA), executive dysfunction (ED), apathy, and depression; 2. anterior thalamus [R]: ARA, inattention, apathy, and aggressiveness; 3. dorsomedian thalamus [L]: inattention, ED, anosognosia, and aggressiveness; 4. central paramedian thalamus [R]: EA, visual perception deficits (VPD), ED, infantility, and personality disorder; 5. caudate nucleus (ventral-head) [L]: VPD, ED, delirium, visual hallucinations, and personality disorder; and 6. anterior capsule [L]: VPD, ED, apathy, and depression. Vascular strategic syndromes connote the predominantly impaired cognitive/behavioral symptom of each site. Temporal and frontal disconnection symptoms were produced by disrupted MTT/hippocampal and IML/amygdala circuits expressing amnesic syndrome associated with heterogeneous dysexecutive syndrome, in all the cases, by disrupting frontal-basal ganglia-thalamus-cortical net, in three different levels of their pathway.
authors.affiliation: Centro para Doença de Alzheimer, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (CDA/IPUB/UFRJ), Rio de Janeiro RJ, Brazil. deo_lanna@terra.com.br
authors.forename: Maria Elisa de Oliveira
authors.initials: ME
authors.lastname: Lanna
authors.forename: Carlos Eduardo O
authors.initials: CE
authors.lastname: Alves
authors.forename: Felipe Kenji
authors.initials: FK
authors.lastname: Sudo
authors.forename: Gilberto
authors.initials: G
authors.lastname: Alves
authors.forename: Letice
authors.initials: L
authors.lastname: Valente
authors.forename: Denise Madeira
authors.initials: DM
authors.lastname: Moreira
authors.forename: José Luiz Sá
authors.initials: JL
authors.lastname: Cavalcanti
authors.forename: Eliasz
authors.initials: E
authors.lastname: Engelhardt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001931:Brain Mapping; D003072:Cognition Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D015140:Dementia, Vascular / Q000150:complications* / Q000000981:diagnostic imaging; D045785:Diterpenes, Clerodane; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: C543871:(5R,10R)-4R,8R-dihydroxy-2S,3R:15,16-diepoxycleroda-13(16),17,12S:18,1S-dilactone; D045785:Diterpenes, Clerodane