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Cognitive disconnective syndrome by single strategic strokes in vascular dementia

  • Maria Elisa de Oliveira Lanna
    Correspondence
    Corresponding author at: Setor de Neurologia Cognitiva e do Comportamento, INDC/UFRJ. Av. Venceslau Brás, 95, Campus Praia Vermelha, Cep: 22290‐140, Rio de Janeiro RJ, Brazil. Tel.: +55 21 2540 0659; fax: +55 21 2295 9794.
    Affiliations
    Centro para Doença de Alzheimer, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (CDA/IPUB/UFRJ), Rio de Janeiro RJ, Brazil

    Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto (INDC/UFRJ), Rio de Janeiro RJ, Brazil
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  • Carlos Eduardo O. Alves
    Affiliations
    Centro para Doença de Alzheimer, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (CDA/IPUB/UFRJ), Rio de Janeiro RJ, Brazil
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  • Felipe Kenji Sudo
    Affiliations
    Centro para Doença de Alzheimer, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (CDA/IPUB/UFRJ), Rio de Janeiro RJ, Brazil
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  • Gilberto Alves
    Affiliations
    Centro para Doença de Alzheimer, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (CDA/IPUB/UFRJ), Rio de Janeiro RJ, Brazil
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  • Letice Valente
    Affiliations
    Centro para Doença de Alzheimer, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (CDA/IPUB/UFRJ), Rio de Janeiro RJ, Brazil
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  • Denise Madeira Moreira
    Affiliations
    Setor de Neuroimagem, Instituto de Neurologia Deolindo Couto (INDC/UFRJ), Rio de Janeiro RJ, Brazil

    Hospital Pró-Cardíaco, Rio de Janeiro RJ, Brazil
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  • José Luiz Sá Cavalcanti
    Affiliations
    Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto (INDC/UFRJ), Rio de Janeiro RJ, Brazil
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  • Eliasz Engelhardt
    Affiliations
    Centro para Doença de Alzheimer, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (CDA/IPUB/UFRJ), Rio de Janeiro RJ, Brazil

    Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto (INDC/UFRJ), Rio de Janeiro RJ, Brazil
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Published:August 30, 2012DOI:https://doi.org/10.1016/j.jns.2012.08.004

      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.

      Keywords

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