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Rapid Communication| Volume 160, ISSUE 1, P96-99, September 18, 1998

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Alzheimer's disease with asymmetric parietal lobe atrophy: A case report

      Abstract

      A 52-year-old, right-handed female presented with visuospatial dysfunction including left hemineglect, incomplete Balint's syndrome, and environmental agnosia, together with left-sided motor symptoms such as unskillful movement, dystonic postures, and myoclonus in the left hand, without significant dementia. Symptoms progressed to akinetic mutism prior to her death 10 years after onset of illness. Imaging studies such as MRI, SPECT, and PET studies showed severe, predominantly right-sided involvement of parietal and parieto-occipital areas. The motor signs might originate from the right parietal lesions such as area five or somatosensory area. Neuropathologic studies including immunocytochemistry showed tau-positive neurofibrillary tangles and abundant neuritic plaques with amyloid deposits, confirming the diagnosis of Alzheimer's disease. An analysis of serum apolipoprotein E revealed ε3/ε3 homozygosity. This case represents a variant of Alzheimer's disease conspicuous for progressive motor signs and visuospatial dysfunction with a striking laterality, reflecting asymmetric parietal involvement. Alzheimer's disease with asymmetric parietal atrophy is difficult to be clinically distinguished from corticobasal degeneration characterized by progressive unilateral motor signs and focal cortical signs.

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      References

        • Albert M.L
        A simple test of visual neglect.
        Neurology. 1973; 23: 658-664
        • Ball J.A
        • Lantos P.L
        • Jackson M
        • Marsden C.D
        • Scadding J.W
        • Rossor M.N
        Alien hand sign in association with Alzheimer's histopathology.
        J. Neurol. Neurosurg. Psychiatry. 1993; 56: 1020-1023
        • Cambier J
        • Masson M
        • Dairou R
        • Henin D
        Étude anatomoclinique forme pariétale de maladie de Pick.
        Rev. Neurol. 1981; 137: 33-38
        • Ceccaldi M
        • Poncet M
        • Gambarelli D
        • Guinot H
        • Billé J
        Apraxie unilat and ale gauche d'aggravation progressive dans deux cas de maladie d'Alzheimer.
        Rev. Neurol. (Paris). 1995; 151: 240-246
        • Crystal H.A
        • Horoupian D.S
        • Katzman R
        • Jotkowitz S
        Biopsy-proved Alzheimer disease presenting as a right parietal lobe syndrome.
        Ann. Neurol. 1982; 12: 186-188
        • Faden A.I
        • Townsend J.J
        Myoclonus in Alzheimer disease: a confusing sign.
        Arch. Neurol. 1976; 33: 278-280
        • Ghika J
        • Bogousslavsky J
        • Uske A
        • Regli F
        Parietal kinetic ataxia without proprioceptive deficit.
        J. Neurol. Neurosurg. Psychiatry. 1995; 59: 531-533
        • Gibb R.G
        • Luthert P.J
        • Marsden C.D
        Corticobasal degeneration.
        Brain. 1989; 112: 1171-1192
        • Hikosaka O
        • Tanaka M
        • Sakamoto M
        • Iwamura Y
        Deficits in manipulative behaviors by local injections of muscimol in the first somatosensory cortex of the conscious monkey.
        Brain Res. 1985; 325: 375-380
        • Jagust W.J
        • Davies P
        • Tiller-Borcich J.K
        • Reed B.R
        Focal Alzheimer's disease.
        Neurology. 1990; 40: 14-19
        • Khachaturian Z.S
        Diagnosis of Alzheimer's disease.
        Arch Neurol. 1985; 42: 1097-1104
        • Lehtovirta M
        • Soininen H
        • Helisalmi S
        • Mannermaa A
        • Helkala E.-L
        • Hartikainen P
        • Hanninen T
        • Ryynanen M
        • Riekkinen P.J
        Clinical and neuropsychological characteristics in familial and sporadic Alzheimer's disease: Relation to apolipoprotein E polymorphism.
        Neurology. 1996; 46: 413-419
      1. Mirra SS, Heyman A, McKeel D, Sumi SM, Cram BJ, Brownlee LM, Vogel FS, Hughes JP, van Belle G, Berg L, participating CERAD neuropathologists. The consortium to establish a registry for Alzheimer's disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology 1991;41:479–86.

        • Mitani K
        • Uchihara T
        • Tamaru F
        • Endo K
        • Tsukagoshi H
        Corticobasal degeneration: clinico-pathological studies on two cases.
        Clin. Neurol. 1993; 33: 155-161
        • Motomura N
        • Yamadori A
        • Asaba H
        • Sakai T
        • Sawada T
        Failure to manipulate objects secondary to active touch disturbance.
        Cortex. 1990; 26: 473-477
        • Muramoto T
        • Kitamoto T
        • Koga H
        • Tateishi J
        The coexistence of Alzheimer's disease and Creutzfeldt-Jakob disease in a patient with dementia of long duration.
        Acta Neuropathol. 1992; 84: 686-689
        • Uchihara T
        • Inaba A
        • Yokota T
        • Furukawa T
        Pure progressive clumsiness due to parietal atrophy in a young adult.
        J. Neurol. Sci. 1996; 143: 173-175