Neurology Resident and Fellow Section

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Presentation transcript:

Neurology Resident and Fellow Section Posterior Territory Stroke with Parahippocampal Involvement: A neglected Cause of Neglect Teaching NeuroImages Neurology Resident and Fellow Section © 2018 American Academy of Neurology

Vignette 87-year old man Presented with a stroke in the right posterior territory At first, he was thought to have a left homonymous hemianopia Which was discovered to be a visual neglect upon further testing Maaijwee et al. © 2018 American Academy of Neurology

Video 1: Head turned right: Patient reads headline on left side of page. 2: Head and trunk aligned: Patient reads article on right side of page. Despite asking explicitly to read article on left side of page, he cannot find it. 3. Head turned right: patient quickly recognizes previously read headline. Maaijwee et al. © 2018 American Academy of Neurology

Imaging Brain-MRI: DWI-Sequence (left) and ADC-Sequence (right), showing a stroke in the right posterior cerebral artery territory involving the parahippocampal gyrus (see arrow) Maaijwee et al. © 2018 American Academy of Neurology

Posterior territory stroke with parahippocampal involvement: A neglected cause of neglect The tip of the occipital lobe was spared and therefore complete hemianopia is not to be expected Visual neglect is common with parahippocampal gyrus involvement Hemianopia and visual neglect can be tested for separately, by turning the body of the patient to the left and his head to the right, because the neglect is body centered References: Mort DJ MP, Mannan SK, Rorden C, Pambakian A, Kennard C, Husain M. The Anatomy of Visual Neglect. Brain 2003;126:1986-1997. Nyffeler T PR, Hopfner S, Job O, Nef T, Pflugshaupt T, Vanbellingen T, Bohlhalter S, Müri RM, Kerkhoff G, Cazzoli D. Contralesional Trunk Rotation Dissociates Real vs. Pseudo-Visual Field Defects due to Visual Neglect in Stroke Patients. Frontiers in Neurology 2017;8:411. Maaijwee et al. © 2018 American Academy of Neurology