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Cognitive functioning in patients with a small infarct in the brainstem

Published online by Cambridge University Press:  26 February 2020

Martine Van Zandvoort*
Affiliation:
Psychological Laboratory, Helmholtz Institute, Utrecht University, The Netherlands Department of Neurology, University Medical Center, Utrecht, The Netherlands
Edward De Haan
Affiliation:
Psychological Laboratory, Helmholtz Institute, Utrecht University, The Netherlands
Jan Van Gijn
Affiliation:
Department of Neurology, University Medical Center, Utrecht, The Netherlands
Laurens Jaap Kappelle
Affiliation:
Department of Neurology, University Medical Center, Utrecht, The Netherlands
*
Reprint requests to: Martine J.E. Van Zandvoort, Ph.D., Psychological Laboratory, Helmholtz Institute, Utrecht University, Heidelberglaan 2, NL-3584 CS Utrecht, The Netherlands. E-mail: [email protected]

Abstract

Earlier findings in patients with a small supratentorial white matter infarct demonstrated subtle impairments of cognition. This is in line with reported difficulties in regaining premorbid level of functioning in daily life activities, even though any physical neurological deficits are no longer present. Either a “bystander effect” of adjoining gray matter or a long distance effect through hypometabolism or other neurochemical changes might underlie these impairments. To find the best explanation, a group of 17 patients with a lacunar infarct in the brainstem was neuropsychologically evaluated and compared with a closely matched control group. The patients demonstrated significantly impaired task performance on a constellation of neuropsychological tasks that was very similar to the findings previously found in patients with a supratentorial lacunar infarct (Boston Naming Test, TEA visual elevator, category fluency, Trailmaking Test). We conclude that a small white-matter infarct may affect cognitive functioning in a nonspecific way independently of its location. (JINS, 2003, 9, 490–494.)

Type
Brief Communication
Copyright
Copyright © The International Neuropsychological Society 2003

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References

Basso, A., Della Sala, S., & Farabola, M. (1987). Aphasia arising from pure deep lesions. Cortex, 23, 2944.10.1016/S0010-9452(87)80017-5CrossRefGoogle Scholar
Chua, K.S.G. & Kong, K. (1996). Functional outcome in brain stem stroke patients after rehabilitation. Archives of Physical Medicine Rehabilitation, 77, 194197.10.1016/S0003-9993(96)90167-7CrossRefGoogle ScholarPubMed
Clavier, I., Hommel, M., Besson, G., Noelle, B., & Perret, J.E. (1994). Long-term prognosis of symptomatic lacunar infarcts. A hospital-based study. Stroke, 25, 20052009.10.1161/01.STR.25.10.2005CrossRefGoogle ScholarPubMed
De Haan, R.J., Limburg, M., Van der Meulen, J.H., Jacobs, H.M., & Aaronson, N.K. (1995). Quality of life after stroke. Impact of stroke type and lesion location. Stroke, 26, 402408.10.1161/01.STR.26.3.402CrossRefGoogle ScholarPubMed
Ferro, J.M. & Kertesz, A. (1984). Posterior internal capsule infarction associated with neglect. Archives of Neurology, 41, 422424.10.1001/archneur.1984.04050160084020CrossRefGoogle ScholarPubMed
Fisher, C.M. (1991). Lacunar infarcts: A review. Cerebrovascular Diseases, 1, 311320.10.1159/000108861CrossRefGoogle Scholar
Hochstenbach, J.B.H., Mulder, T., van Limbeek, J., Donders, R., & Schoonderwaldt, H. (1998). Cognitive decline following stroke: A comprehensive study of cognitive decline following stroke. Journal of Clinical and Experiment Neuropsychology, 20, 503517.10.1076/jcen.20.4.503.1471CrossRefGoogle ScholarPubMed
Kim, J.S. & Choi-Kwon, S. (2000). Poststroke depression and emotional incontinence: Correlation with lesion location. Neurology, 54, 18051810.10.1212/WNL.54.9.1805CrossRefGoogle ScholarPubMed
Kinomura, S., Larsson, J., Gulyas, B., & Roland, P.E. (1996). Activation by attention of the human reticular formation and thalamic intralaminar nulcei. Science, 271, 512515.CrossRefGoogle Scholar
Kwan, L.T., Reed, B.R., Eberling, J.L., Schuff, N., Tanabe, J.L., Norman, D., Weiner, M.W., & Jagust, W.J. (1999). Effects of subcortical cerebral infarction on cortical glucose metabolism and cognitive function. Archives of Neurology, 56, 809814.CrossRefGoogle ScholarPubMed
Lanfermann, H., Kugel, H., Heindel, W., Helholz, K., Heiss, W.D., & Lackner, K. (1995). Metabolic changes in acute and subacute cerebral infarctions: findings at proton MR spectroscopic imaging. Radiology, 196, 203210.10.1148/radiology.196.1.7784568CrossRefGoogle ScholarPubMed
Malm, J., Kristensen, B., Carlberg, B., Fagerlund, M., & Olsson, T. (1999). Clinical features and prognosis in young adults with infratentorial infarct. Cerebrovascular Diseases, 9, 282289.10.1159/000015979CrossRefGoogle Scholar
Metter, E.J., Mazziotta, J.C., Itabashi, H.H., Mankovich, N.J., Phelps, M.E., & Kuhl, D.E. (1985). Comparison of glucose metabolism, x-ray CT, and postmortem data in a patient with multiple cerebral infarcts. Neurology, 35, 16951701.10.1212/WNL.35.12.1695CrossRefGoogle Scholar
Nelles, G., Contois, K.A., Valente, S.L., Higgins, J.L., Jacobs, D.H., Kaplan, J.D., & Pessin, M.S. (1998). Recovery following lateral medullary infarction. Neurology, 50, 14181422.CrossRefGoogle ScholarPubMed
Steckler, T., Inglis, W., Winn, P., & Sahgal, A. (1994). The pedunculopontine tegmental nucleus: A role in cognitive processes? Brain Research Reviews, 19, 298318.Google ScholarPubMed
Sturm, W., de Simone, A., Krause, B.J., Specht, K., Hesselman, V., Radermacher, I., Herzog, H., Tellman, L., & Willmes, K. (1999). Functional anatomy of intrinsic alertness: Evidence for a fronto– parietal–thalamic–brainstem network in the right hemisphere. Neuropsychologia, 37, 797805.10.1016/S0028-3932(98)00141-9CrossRefGoogle ScholarPubMed
Van der Werf, Y.D., Weerts, J.G.E., Jolles, J., Witter, M.P., Lindeboom, J., & Scheltens, P. (1999). Neuropsychological correlates of a right unilateral lacunar thalamic infarction. Journal of Neurology, Neurosurgery and Psychiatry, 66, 3642.10.1136/jnnp.66.1.36CrossRefGoogle ScholarPubMed
Van Zandvoort, M.J.E., Aleman, A., Kappelle, L.J., & De Haan, E.H.F. (2000). Cognitive functioning before and after a lacunar infarct. Cerebrovascular Diseases, 10, 478479.10.1159/000016112CrossRefGoogle ScholarPubMed
Van Zandvoort, M.J.E., De Haan, E.H.F., & Kappelle, L.J. (2001). Chronic cognitive disturbances after a supratentorial lacunar infarct. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 14, 98102.Google ScholarPubMed
Van Zandvoort, M.J.E., Kappelle, L.J., Algra, A., & de Haan, E.H.F. (1998). Decreased capacity for mental effort after single supratentorial lacunar infarct may affect performance in everyday life. Journal of Neurology, Neurosurgery and Psychiatry, 65, 697702.10.1136/jnnp.65.5.697CrossRefGoogle ScholarPubMed