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.
Keywords
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Article info
Publication history
Accepted:
May 25,
1998
Received in revised form:
May 20,
1998
Received:
November 5,
1997
Identification
Copyright
© 1998 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
