Clinical Short Communication| Volume 372, P496-500, January 15, 2017

Major neurocognitive disorder followıng isolated hippocampal ischemıc lesions

Published:November 03, 2016DOI:


      • The hippocampus is a part of limbic system playing important roles in the memory systems.
      • 4 of 22 (18%) patients with isolated hippocampal infarcts presented major neurocognitive disorder.
      • Visual memory and spatial working memory, remembering the location of specific objects and the precise location metric coordinates were also disturbed.
      • Major cognitive disorder was developed due to anterior involvement of the hippocampus with little interindividual variation.
      • Verbal, visual memory and other cognitive deficits of our patients interfered with independence of everyday activities.


      Background and purpose

      Major cognitive disorder (MND) following vascular events is known as second causes of dementia after Alzheimer's disease (AD). Acute onset MND due to isolated hippocampal infarction has not been recognized as a specific subtype of vascular dementia, and there is no validated criteria for the identification of such cases, either clinically or radiologically.


      Among 7200 patients with first-ever ischemic stroke, 22 patients (0.3%) showed acute isolated ischemic lesions in the hippocampus. Four of them presented acute MND characterized by confusion at the beginning of stroke and thereafter they developed typical clinical characteristics of MND. These cases allowed us to delineate a specific type of dementia characterized by confusion at stroke onset, dull and aimless appearance, verbal and visual immediate or delayed memory deficits, dysexecutive syndrome. Major cognitive disorder was developed due to anterior involvement of the hippocampus with little interindividual variation. Stroke mechanism was artery-to-artery embolism or cardioembolism which can explain isolated infarcts of the hippocampus.


      Hippocampal MND generally occurred in acute bilateral isolated hippocampal infarcts. The clinical characteristic of MND may be secondary to lesions of the body of the hippocampus and interruption of the hippocampo-temporal pathways and cortical projections.


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