ABSTRACT
We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.
ABSTRACT
We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.
ABSTRACT
Resumen La prosopagnosia es un tipo de agnosia visual caracterizada por la incapacidad de reconocer los rostros de las personas. Existen básicamente dos variantes, aperceptivas y asociativas. El "efecto Tortoni" es un fenómeno descripto por Bekinschtein y col. hace unos años en mozos de café en Buenos Aires, quienes utilizaban esta herramienta para recordar los pedidos de cada integrante de una mesa. Presentamos un caso de prosopagnosia asociada a lesión temporo-occipital bilateral secundaria a traumatismo encefalocra neano, manifestada en forma inicial por la falta de reconocimiento de rostros, con la utilización de una estra tegia asociativa similar a la descripta en el efecto "Tortoni" como compensación. Mujer de 62 años que sufrió un traumatismo encefalocraneano grave. Pocos meses después del evento, presentó dificultad para reconocer personas conocidas, hecho evidenciado por sus allegados cuando en una mesa los integrantes cambiaron su asiento, permanecieron callados por unos instantes, y posteriormente la paciente continuó nombrándolos por su ubicación previa. En la resonancia magnética de cerebro se objetivaron lesiones contusas de aspecto secuelar en región temporo-occipital bilateral. La prosopagnosia adquirida secundaria a lesiones focales en la región temporo-occipital generalmente bilateral, derecha, y raramente izquierda, es un cuadro poco frecuente. La es trategia utilizada en el "efecto Tortoni" fue en nuestra paciente una de las manifestaciones iniciales del cuadro. La realización de un test neuropsicológico ecológico que considere esta estrategia podría ser de utilidad en el rastreo y detección precoz de esta entidad.
Abstract Proposapnosia is a type of visual agnosia characterized by the inability to recognize people's faces. There are basically two variants, apperceptive and associative. The "Tortoni effect" is a phenomenon described by Bekinschtein et al a few years ago in waiters from Buenos Aires, who used this tool to remember the orders of each member of a table. We present a case of prosopagnosia associated with bilateral temporo-occipital injury secondary to head trauma, initially manifested by the lack of face recognition with the use of an associative strategy similar to that described in the "Tortoni effect" as compensation, in a 62-year-old female who suffered a severe head injury. A few months after this event, the patient had difficulty in recognizing familiar people, a fact evidenced by her relatives when at a restaurant table, they changed their seats, remained silent momentarily, and right after the patient kept naming them by their previous location. The magnetic resonance imaging of the brain revealed blunt sequelae lesions in the bilateral temporo-occipital region. Acquired prosopagnosia due to focal lesions in the temporo-occipital region, generally bilateral and right, and less frequently left, is a rare condition. The strategy used in the "Tortoni effect" was one of the initial manifestations of the condition in our patient. Carrying out an ecological neuropsychological test that considers this strategy could be useful in the screening and early detection of this entity.
Subject(s)
Humans , Female , Middle Aged , Prosopagnosia/diagnosis , Prosopagnosia/etiology , Brain , Magnetic Resonance Imaging , Neuropsychological TestsABSTRACT
Presentamos dos casos de demencia de inicio antes de los 65 años de edad con apraxia y manifestaciones visuo-espaciales, en los cuales no hay trastornos de memoria y de la conducta, y con diferentes grados de evolución ademencia. Las imágenes estructurales del cerebro demuestran atrofia parieto-occipital. Ambos casos reúnen los criterios de atrofia cortical posterior (ACP).
We present two cases of progressive early, onset dementia with apraxia and visuospatial disability as initial manifestations, in which there is no memory and behavior disorders, and with different degrees of progression to dementia. Structural neuroimaging demonstrated parieto-occipital atrophy. These cases fulfil the diagnostic criteria of posterior cortical atrophy (PCA).
Subject(s)
Female , Aged , Agnosia , Atrophy , Dementia , Alzheimer DiseaseABSTRACT
La agnosia integrativa es un tipo de agnosia visual asociada a lesiones occipitales bilaterales que se caracteriza por la incapacidad para identificar estímulos en fondos complejos, especialmente, cuando se trata de formas superpuestas o entrelazadas. Existen dificultades para codificar y agrupar el todo a partir de las partes del estímulo. Se presenta un caso de una paciente de 14 años, con una agnosia integrativa como consecuencia de una epilepsia focal sintomática refractaria, con un foco epileptogénico occipital izquierdo. Se plantean las características clínicas de la paciente y se hace un análisis de sus procesos de reconocimiento visual discutidos a partir de los diferentes modelos teóricos que tratan de explicar la percepción visual.
Integrative agnosia is a type of visual agnosia associated with bilateral occipital lesions and characterized by the inability to identify stimuli in complex backgrounds, especially when it comes to overlapping or interlocking shapes. There are difficulties in coding and grouping the whole from the parts of the stimulus. We report a case of a 14 year-old female, with integrative agnosia as consequence of refractory symptomatic focal epilepsy with left occipital epileptogenic focus. Clinical features and the visual recognition processes are analyzed and discussed from different theoretical models that attempt to explain visual perception.
ABSTRACT
Progressive posterior cortical dysfunction (PPCD) is an insidious syndrome characterized by prominent disorders of higher visual processing. It affects both dorsal (occipito-parietal) and ventral (occipito-temporal) pathways, disturbing visuospatial processing and visual recognition, respectively. We report a case of a 67-year-old woman presenting with progressive impairment of visual functions. Neurologic examination showed agraphia, alexia, hemispatial neglect (left side visual extinction), complete Balint?s syndrome and visual agnosia. Magnetic resonance imaging showed circumscribed atrophy involving the bilateral parieto-occipital regions, slightly more predominant to the right . Our aim was to describe a case of this syndrome, to present a video showing the main abnormalities, and to discuss this unusual presentation of dementia. We believe this article can contribute by improving the recognition of PPCD.
Disfunção cortical posterior progressiva (DCPP) é um síndrome insidiosa caracterizada por distúrbios do processamento visual superior. Ela afeta tanto a via dorsal (occipito-parietal) como a ventral (occipito-temporal), alterando o processamento visuoespacial e reconhecimento visual, respectivamente. Nós relatamos o caso de uma mulher de 67 anos com dificuldade progressiva nas funções visuais. O exame neurológico mostrou agraphia, alexia, negligência especial (extinção visual à esquerda), síndrome de Balint complete e agnosia visual. A ressonância magnética mostrou atrofia nas regiões parieto-occipitais, mais evidente à direita. Nosso objetivo foi descrever um caso desta síndrome, apresentar um vídeo mostrando as principais anormalidades e discutir esta apresentação incomum de demência. Nós esperamos que o artigo possa facilitar o reconhecimento da DCPP.
Subject(s)
Humans , Vision Disorders , AgnosiaABSTRACT
@#Kluver-Bucy syndrome (KBS) is a rare neuropsychiatric disorder. The characteristics of KBS include visual agnosia, hyperorality, changes in dietary habits, hypermetamorphosis, placidity, hypersexuality, and etc. However, some features like aphasia, amnesia,dementia and seizure are probably exclusive to humans. KBS is usually associated with lesions of the bilateral temporal lobe.
ABSTRACT
Optic aphasia is a rare syndrome in which patients are unable to name visually presented objects but have no difficulty in naming those objects on tactile or verbal presentation. We report a 79-year-old man who exhibited anomic aphasia after a left posterior cerebral artery territory infarction. His naming ability was intact on tactile and verbal semantic presentation. The results of the systematic assessment of visual processing of objects and letters indicated that he had optic aphasia with mixed features of visual associative agnosia. Interestingly, although he had difficulty reading Hanja (an ideogram), he could point to Hanja letters on verbal description of their meaning, suggesting that the processes of recognizing objects and Hanja share a common mechanism.