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NEUROPSYCHOLOGICAL SYMPTOMS AND THERAPY IN PATIENT WITH A BILATERAL THALAMIC ISCHEMIC STROKE DUE TO THE ARTERY OF PERCHERON TERRITORY INFARCT

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Peda B., Kotlęga D., Gołąb-Janowska M., Nowacki P.
Acta Neuropsychologica
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2017
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vol. 15(3)
341-355
EN
A bilateral thalamic ischemic stroke is a rare clinical manifestation resulting mainly from cardioembolism or small vessel disease. The ischemic stroke affecting the thalamus bilaterally may lead to memory and executive dysfunction, dis o rientation, oculomotor and conjugated gaze disturbances, motor deficit, cerebellar symptoms, apathy, stupor, somnolence and a coma. There have only been a few descriptions of the neuropsychological condition prevalent in this group of patients. The aim of the study was to present a detailed neuropsychological manifestation and follow-up with systematic rehabilitation. We present a 57-year-old female patient suffering from a bilateral thalamic ischemic stroke due to cardiogenic embolism of the artery of Percheron. The presented case summarizes the dynamics of the changes in cognitive and executive functions in the patient over the course of six months from the onset. We conclude that all bilateral stroke patients should undergo a detailed neuropsychological assess ment, an early, intensive rehabilitation process and a full cardiac investigation to unearth the potential causes.
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NEUROPSYCHOLOGICAL CHARACTERISTIC OF COGNITIVE DISORDERS IN PATIENT WITH CLIPPERS SYNDROME

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Peda B., Kotlęga D., Masztalewicz M., Nowacki P.
Acta Neuropsychologica
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2020
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vol. 18(3)
393-401
EN
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a novel inflammatory central nervous system disorder. The diagnosis is made on the basis of the radiological, neurological, neuro - pathological data and responsiveness to steroids treatment. The aim of this paper is to present a neuropsychological characteristic of cognitive, executive and linguistic symptoms characteristic for patient with CLIPPERS disease. In this paper we present the case of a 42-year-old woman with hyperintense punctate foci in the pons, cerebellum, mid- brain, thalamus, white matter of occipital lobes, with a short- term verbal memory deficits, mild deficiency in verbal and pro cedural learning, executive dysfunctions, hand-eye co ordi - nation impairment, psychomotor speed disabilities and dysarthria, associated with a chronic lymphocytic inflammation. In this challenging diagnosis of CLIPPERS, neuropsychological analysis of cognitive functions can be important to optimize the diagnosis and treatment.
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Stroke mimics: a psychogenic stroke patient treated with alteplase

76%
Kotlęga D., Peda B., Trochanowski T., Gołąb-Janowska M., Ciećwież S., Nowacki P.
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vol. 17(1)
97-102
EN
For rtPA treatment to be effective it should be initiated within the first 4.5 hours following the onset of a stroke. Such a short therapeutic window demands a rapid diagnosis and decision making on the part of the physician. There are patients with stroke-like symptoms and an initial diagnosis of a stroke, but who are finally diagnosed as suffering from another condition. According to the subject literature, stroke mimics are diagnosed in about 1.4 – 3.5% of patients initially diagnosed as having had an ischemic stroke. Psychogenic strokes (conversion disorders) may be found in as many as 8.2% of stroke patients. Proper diagnosis is especially important in patients eligible for thrombolytic treatment when there is usually not enough time to establish the diagnosis of a stroke mimic, especially one of psychogenic origin. A patient with an initial diagnosis of an ischemic stroke who was treated with intravenous alteplase infusion. The previous two ischemic strokes treated in the same manner had been diagnosed one and two years earlier. In all hospitalizations no rtPA treatment complications had been observed. In our patient a proper neuropsychological examination was performed and a conversion disorder diagnosed. We would like to underline the importance of cooperation between the neuropsychologist and neurology physician within clinical practice.
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