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1
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Barany L, Meszaros C, Alpar A, Ganslandt O, Hore N, Delev D, Schnell O, Kurucz P. Topographical anatomy of the septum verum and its white matter connections. Sci Rep 2024; 14:18064. [PMID: 39103521 PMCID: PMC11300447 DOI: 10.1038/s41598-024-68464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/24/2024] [Indexed: 08/07/2024] Open
Abstract
The human septum verum represents a small but clinically important region of the brain. Based on the results of animal experiments, the stimulation of its medial part was recently proposed with various indications like epilepsy or cognitive impairment after traumatic brain injury. The aim of our study was to present the anatomical relationships of the human septum verum using fiber dissection and histological analysis to support its research and provide essential information for future deep brain stimulation therapies. 16 human cadaveric brains were dissected according to Klingler's method. To validate our macroscopical findings, 12 samples obtained from the dissected brains and 2 additional specimens from unfrozen brains were prepared for histological examinations. We identified the following white matter connections of the septum verum: (1) the precommissural fibers of the fornix; (2) the inferior fascicle of the septum pellucidum; (3) the cingulum; (4) the medial olfactory stria; (5) the ventral amygdalofugal pathway; (6) the stria medullaris of the thalamus and (7) the stria terminalis. Moreover, we could distinguish a less-known fiber bundle connecting the postcommissural column of the fornix to the stria medullaris of the thalamus and the anterior thalamic nuclei. In this study we present valuable anatomical information about this region to promote safe and effective deep brain stimulation therapies in the future.
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Affiliation(s)
- Laszlo Barany
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Cintia Meszaros
- Department of Anatomy, Semmelweis University, Budapest, Hungary
| | - Alan Alpar
- Department of Anatomy, Semmelweis University, Budapest, Hungary
- SE NAP Research Group of Experimental Neuroanatomy and Developmental Biology, Semmelweis University, Budapest, Hungary
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Nirjhar Hore
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Daniel Delev
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter Kurucz
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
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Jiang Y, Chen S, Wu D, He W, Ma X, Zhang L, Zhang Q. Case report: Symmetrical and increased lateral sway-based walking training for patients with corpus callosum infarction: a case series. Front Neurol 2024; 15:1330975. [PMID: 38978808 PMCID: PMC11228249 DOI: 10.3389/fneur.2024.1330975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/31/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction Corpus callosum injury is a rare type of injury that occurs after a stroke and can cause lower limb dysfunction and a decrease in activities of daily living ability. Furthermore, there are no studies that focus on the progress in rehabilitation of the lower limb dysfunction caused by infarction in the corpus callosum and the effective treatment plans for this condition. We aimed to present a report of two patients with lower limb dysfunction caused by corpus callosum infarction after a stroke and a walking training method. Methods We implemented a walking training method that prioritizes bilateral symmetry and increases lateral swaying before the patients established sitting/standing balance. The plan is a rapid and effective method for improving walking dysfunction caused by corpus callosum infarction. Case characteristics Following sudden corpus callosum infarction, both patients experienced a significant reduction in lower limb motor function scores and exhibited evident gait disorders. Scale evaluations confirmed that walking training based on symmetrical and increased lateral sway for patients with lower limb motor dysfunction after corpus callosum infarction led to significant symptom improvement. Conclusion We report two cases of sudden motor dysfunction in patients with corpus callosum infarction. Symmetrical and increased lateral sway-based walking training resulted in substantial symptom improvement, as confirmed by scale assessments.
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Affiliation(s)
- Ying Jiang
- Department of Rehabilitation, Jiangsu Zhongshan Geriatric Rehabilitation Hospital, Nanjing, Jiangsu, China
| | - Sijing Chen
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dan Wu
- Department of Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Wei He
- Department of Rehabilitation, Rehabilitation Hospital Affiliated to Nanjing Institute of Physical Education, Wuxi, Jiangsu, China
| | - Xiaoqing Ma
- Department of Rehabilitation, Rehabilitation Hospital Affiliated to Nanjing Institute of Physical Education, Wuxi, Jiangsu, China
| | - Lixia Zhang
- Department of Rehabilitation, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qian Zhang
- Department of Rehabilitation, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
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3
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Bradshaw J, Choi PMC, Wrigley S. Long-term cognitive recovery following isolated bilateral infarction of the fornix presenting with amnesia. BMJ Neurol Open 2024; 6:e000655. [PMID: 38736581 PMCID: PMC11085788 DOI: 10.1136/bmjno-2024-000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Isolated infarction of the fornix is a relatively rare stroke syndrome frequently associated with amnesia. The long-term cognitive outcome in cases of acute fornix infarction is poorly understood. This is largely due to the limited number of case studies that have documented cognitive outcomes beyond the acute recovery phase on quantifiable neuropsychological measures. We describe a patient who developed acute amnesia and was subsequently diagnosed on cerebral MRI with bilateral infarction in the anterior columns of the fornix. Method Comprehensive neuropsychological review was undertaken prospectively at baseline, early and late phases of recovery. Results At 9 months post-stroke, there was some reduction in the severity of memory dysfunction, but a significant anterograde amnesia persisted. Conclusion This is one of the very few cases in the literature where neuropsychological function has been comprehensively and serially examined over the first year post-isolated bilateral fornix infarction. It is concluded that amnesia can persist well beyond 6 months in these cases, with associated functional impairment in daily life.
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Affiliation(s)
- Jennifer Bradshaw
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
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Mazzacane F, Ferrari F, Malvaso A, Mottese Y, Gastaldi M, Costa A, Pichiecchio A, Cavallini A. Acute amnestic syndrome in fornix lesions: a systematic review of reported cases with a focus on differential diagnosis. Front Neurol 2024; 15:1338291. [PMID: 38333604 PMCID: PMC10850356 DOI: 10.3389/fneur.2024.1338291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Acute amnestic syndrome is an uncommon clinical presentation of neurological disease. Differential diagnosis encompasses several syndromes including Wernicke-Korsakoff and transient global amnesia (TGA). Structural lesions of the fornix account for a minority of cases of acute amnestic syndromes. Etiology varies from iatrogenic injury to ischemic, inflammatory, or neoplastic lesions. A prompt diagnosis of the underlying pathology is essential but challenging. The aim of this review is to systematically review the existing literature regarding cases of acute amnestic syndrome associated with non-iatrogenic lesions of the fornix. Methods We performed a systematic literature search on PubMed, Scopus, and Web of Science up to September 2023 to identify case reports and case series of patients with amnestic syndrome due to fornix lesions. The systematic review was conducted according to PRISMA guidelines. The research was limited to articles written in English. Cases of fornix damage directly ascribable to a surgical procedure were excluded. Results A total of 52 publications reporting 55 cases were included in the review. Focusing on acute/subacute onset, vascular etiology was highly prevalent, being responsible for 78% of cases, 40/55 (74%) of which were due to acute ischemic stroke. The amnestic syndrome was characterized by anterograde amnesia in all patients, associated with retrograde amnesia in 27% of cases. Amnesia was an isolated presentation in most cases. Up to two thirds of patients had persistent memory deficits of any severity at follow-up. Discussion Acute amnestic syndrome can be rarely caused by fornix lesions. In most cases of acute/subacute presentation, the etiology is ischemic stroke, mainly caused by strokes involving the subcallosal artery territory. The differential diagnosis is challenging and a distinction from common mimics is often difficult on a clinical basis. A high index of suspicion should be maintained to avoid misdiagnosis and provide adequate acute treatment to patients with time-dependent disease, also employing advanced neuroimaging. More research is needed to better understand the outcome and identify prognostic factors in patients with amnestic syndrome due to fornix lesions.
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Affiliation(s)
- F. Mazzacane
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
- Unit of Behavioral Neurology, Mondino Foundation, Pavia, Italy
| | - F. Ferrari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - A. Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroimmunology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Y. Mottese
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - M. Gastaldi
- Neuroimmunology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - A. Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, Mondino Foundation, Pavia, Italy
| | - A. Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - A. Cavallini
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
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Yang WT, Tang FQ. Isolated bilateral fornix anterior columns infarction with acute amnesia and fiber tracts damage, a case report. Neurocase 2023; 29:186-190. [PMID: 38700142 DOI: 10.1080/13554794.2024.2348762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Isolated fornix anterior column infarction has rarely been described and is difficult to assess accurately using conventional magnetic resonance imaging (MRI). We report the case of a 75-year-old female who experienced acute anterograde amnesia. MRI performed within 24 h after amnesia onset showed an isolated infarction of the bilateral anterior columns of the fornix on diffusion-weighted imaging (DWI). Her symptoms persisted for up to 50 days, and diffusion tensor imaging (DTI) showed disruption of the fiber tracts of the fornix. when acute amnesia syndrome onset, fornix anterior column infarction should be considered, and optimized DWI and DTI methods are needed to study the fornix in vivo in future research.
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Affiliation(s)
- Wen-Ting Yang
- Department of Radiology, Jinhua Hospital of Zhejiang University (Jinhua Municipal Central Hospital), Jinhua, China
| | - Fu-Qiang Tang
- Department of Radiology, Jinhua Hospital of Zhejiang University (Jinhua Municipal Central Hospital), Jinhua, China
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6
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Izgi E, Ayasli A, Ogul Y, Ogul H. Unusual stroke cause: bilaterally fornix infarction in a patient with biotinidase deficiency. QJM 2023; 116:944-946. [PMID: 37522883 DOI: 10.1093/qjmed/hcad180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- E Izgi
- Department of Radiology, Medizinisches Versorgungszentrum Meine Radiologie Tuttlingen GmbH, Tuttlingen, Germany
| | - A Ayasli
- Department of Neurology, Medical Faculty, Duzce University, Duzce, Turkey
| | - Y Ogul
- Duzce Public Health Center, Duzce, Turkey
| | - H Ogul
- Department of Radiology, Medical Faculty, Duzce University, Duzce, Turkey
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7
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The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory. Acta Neurochir (Wien) 2023; 165:501-515. [PMID: 36652012 DOI: 10.1007/s00701-023-05487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes. METHODS The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients' demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated. RESULTS Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99; [Formula: see text]), previous stroke (OR, 3.89; [Formula: see text]), posterior projection (OR, 5.58; [Formula: see text]), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm; [Formula: see text]), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm; [Formula: see text]) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88; [Formula: see text]). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction ([Formula: see text]). CONCLUSION Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach.
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8
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Thapa K, Setyapranata S, Choi PMC, Clare I. Bilateral fornix infarction as a cause of acute amnesia. Acta Neurol Belg 2022:10.1007/s13760-022-02159-w. [PMID: 36478544 PMCID: PMC9734847 DOI: 10.1007/s13760-022-02159-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Kshitij Thapa
- Department of Medicine, Echuca Regional Health, 226 Service St, Echuca, VIC 3564 Australia
| | - Stella Setyapranata
- Department of Medicine, Echuca Regional Health, 226 Service St, Echuca, VIC 3564 Australia
| | - Philip M. C. Choi
- Department of Neuroscience, Eastern Health, Melbourne, Australia ,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Ian Clare
- I-MED Radiology Network, Victoria, Australia
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9
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Holay Q, Piotin M, Escalard S. Subcallosal Occlusion Following Anterior Communicating Aneurysm Treatment. Neurology 2022; 99:522-523. [PMID: 35918166 DOI: 10.1212/wnl.0000000000201067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
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Abstract
Acute episodes of amnestic syndrome can be a challenging diagnostic problem. Except for nonvascular etiology, thalamic strokes or infarction involving several temporal lobe structures has been reported in earlier cases. The authors report a patient who suddenly developed memory loss without any other focal neurologic deficits. Brain magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) performed 1 day after onset revealed acute infarction involving the bilateral fornix column and the genu of corpus callosum. Because simple fornix infarcts often have no obvious positive neurological signs, most of the related manifestations were provided by family members, are easy to be diagnosed falsely, and missed in clinical areas, we suggest that bilateral fornix infarction should be considered in the diagnosis of an acute onset amnestic syndrome.
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Affiliation(s)
- Hui Zhang
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
| | - Ya Zhang
- Department of Neurology, Hebei North University, Zhangjiakou, China
| | - Xin Jiang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
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Hayashi M, Fujimoto A, Enoki H, Niimi K, Inenaga C, Sato K, Homma K, Arakawa T, Okanishi T. The Fornix May Play a Key Role in Korsakoff's Amnesia Secondary to Subcallosal Artery Infarction. Brain Sci 2021; 12:21. [PMID: 35053765 PMCID: PMC8773842 DOI: 10.3390/brainsci12010021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Subcallosal artery infarction injures the fornix and anterior corpus callosum and sometimes causes Korsakoff's amnesia. We hypothesized that Korsakoff's amnesia might be caused by fornix dysfunction rather than anterior corpus callosum dysfunction in subcallosal artery infarction. METHODS A systematic review approach was applied to search PubMed and Google Scholar for articles to compare patients who had both bilateral fornix and corpus callosum infarction due to subcallosal artery territory ischemia (vascular event group; V group) with patients who had undergone anterior corpus callosotomy (callosotomy group; C group). RESULTS The V group comprised 10 patients (mean age, 63 years; median, 69 years; standard deviation (SD), 14.5 years; 5 males, 5 females). The C group comprised 6 patients (mean age, 23.7 years; median, 20 years; SD, 7.3 years; 3 males, 3 females). Six of 10 patients (60%) with subcallosal artery infarction exhibited Korsakoff's amnesia. One patient showed neither confabulation nor amnesia. Conversely, no amnesia episodes were seen in any patients from the C group (p = 0.034). CONCLUSION Fornix injury, rather than anterior corpus callosum injury, might be the major cause of Korsakoff's amnesia in patients with subcallosal artery infarction.
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Affiliation(s)
- Masataka Hayashi
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (M.H.); (C.I.); (T.A.)
| | - Ayataka Fujimoto
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (M.H.); (C.I.); (T.A.)
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (H.E.); (K.S.); (T.O.)
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (H.E.); (K.S.); (T.O.)
| | - Keiko Niimi
- Department of Rehabilitation, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan;
| | - Chikanori Inenaga
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (M.H.); (C.I.); (T.A.)
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (H.E.); (K.S.); (T.O.)
- Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan;
| | - Kazunari Homma
- Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan;
| | - Tomoya Arakawa
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (M.H.); (C.I.); (T.A.)
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan; (H.E.); (K.S.); (T.O.)
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Ghannam M, Alshaer Q, Ukatu H, Alkuwaiti M, Streib C. Acute Amnestic Syndrome and Ischemic Stroke: A Case Series. Neurol Clin Pract 2021; 11:263-267. [PMID: 34484894 DOI: 10.1212/cpj.0000000000000928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
Purpose of Review Stroke is an uncommon cause of amnesia. We describe in detail 3 cases of anterograde amnesia and confabulation secondary to acute ischemic stroke and review the available literature. Recent Findings In our case series, all 3 patients presented with anterograde amnesia and 2 of 3 copresented with prominent confabulation. These symptoms were recognized in delayed fashion, and no patients received IV tissue plasminogen activator (tPA). Although stroke infarct topology was variable, all 3 patients had infarction of the fornix. Long-term follow-up was obtained in 2 of 3 patients: both had persistent memory impairment and were no longer functionally independent. Summary Acute onset anterograde amnesia and confabulation may uncommonly represent acute ischemic stroke. Delays in this diagnosis typically exclude patients from emergent stroke treatment or timely diagnostic stroke evaluation. Clinicians should maintain a high degree of suspicion for ischemic stroke in this setting, especially in patients with comorbid vascular risk factors. Memory impairment secondary to ischemic stroke can produce considerable long-term disability.
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Affiliation(s)
- Malik Ghannam
- Department of Neurology (MG, HU, MA, CS), University of Minnesota, Minneapolis; and Department of Neurology (QA), Emory University, Atlanta, GA
| | - Qasem Alshaer
- Department of Neurology (MG, HU, MA, CS), University of Minnesota, Minneapolis; and Department of Neurology (QA), Emory University, Atlanta, GA
| | - Hope Ukatu
- Department of Neurology (MG, HU, MA, CS), University of Minnesota, Minneapolis; and Department of Neurology (QA), Emory University, Atlanta, GA
| | - Mohammed Alkuwaiti
- Department of Neurology (MG, HU, MA, CS), University of Minnesota, Minneapolis; and Department of Neurology (QA), Emory University, Atlanta, GA
| | - Christopher Streib
- Department of Neurology (MG, HU, MA, CS), University of Minnesota, Minneapolis; and Department of Neurology (QA), Emory University, Atlanta, GA
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Jiang J, Wang X, Chen Y, Shang X. What Causes Anterograde Amnesia? Eur Neurol 2021; 84:139-144. [PMID: 33794519 DOI: 10.1159/000512408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Jiwei Jiang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Xiaoting Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Yutong Chen
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, China
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14
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Cho MJ, Shin DI, Han MK, Yum KS. Acute amnesia during pregnancy due to bilateral fornix infarction: A case report. World J Clin Cases 2020; 8:4494-4498. [PMID: 33083409 PMCID: PMC7559690 DOI: 10.12998/wjcc.v8.i19.4494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stroke is an important cause of maternal morbidity and mortality during pregnancy and puerperium. Isolated amnesia is a rare clinical symptom caused by ischemic stroke during pregnancy. We present the first documented case of acute amnesia during pregnancy due to bilateral fornix infarction.
CASE SUMMARY A 32-year-old nullipara presented at 35 wk of gestation with acute amnesia and headache. Brain magnetic resonance imaging and angiography revealed acute infarction in the bilateral anterior fornix. There was no evidence of causative abnormality after extensive work-up, including for vascular abnormality, cardiac disease, coagulopathy, and pregnancy-related conditions. The patient was diagnosed with cryptogenic stroke. Aspirin was administered immediately, and the patient recovered fully without recurrence.
CONCLUSION Acute isolated amnesia due to stroke is rare during pregnancy. Early diagnosis of stroke and immediate treatment prevent neurologic sequelae.
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Affiliation(s)
- Min Jai Cho
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju-si 28644, South Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju-si 28644, South Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si 463-707, South Korea
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju-si 28644, South Korea
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15
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Ji Y, Xie Y, Wang T, Cao D, Li J, Han J, Ji G, Zhao S, Kang Z. Four patients with infarction in key areas of the Papez circuit, with anterograde amnesia as the main manifestation. J Int Med Res 2020; 48:300060520939369. [PMID: 32686968 PMCID: PMC7372620 DOI: 10.1177/0300060520939369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Papez circuit is an important brain structure that is closely associated with
learning and memory. In this report, we present four patients with anterograde amnesia as
the main manifestation induced by Papez circuit infarction. In addition, we review the
distribution of the responsible arteries in key and rare regions to investigate the
pathogenesis of these infarctions.
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Affiliation(s)
- Ye Ji
- Department of Neurological Function Examination, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Yanan Xie
- Department of Cardiovascular Diseases, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Tingting Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Duanhua Cao
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Jin Li
- Department of Neurological Function Examination, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Jingzhe Han
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Guang Ji
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Song Zhao
- Department of MRI, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhilei Kang
- Department of MRI, Harrison International Peace Hospital, Hengshui, Hebei, China
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Holla VV, Pene SS, Rakesh Sharma MN. Acute Amnestic Syndrome - "Watch Out" for Fornix Infarct. Neurol India 2020; 68:498-499. [PMID: 32189703 DOI: 10.4103/0028-3886.280642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Vikram V Holla
- Department of Neurology, Narayana Multispecialty Hospital, Mysuru, Karnataka, India
| | | | - M N Rakesh Sharma
- Department of Radiology, Narayana Multispecialty Hospital, Mysuru, Karnataka, India
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17
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Mugikura S, Mori N, Kikuchi H, Mori E, Takahashi S, Takase K. Relationship between decreased cerebral blood flow and amnesia after microsurgery for anterior communicating artery aneurysm. Ann Nucl Med 2020; 34:220-227. [PMID: 31989467 PMCID: PMC7033071 DOI: 10.1007/s12149-020-01436-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
Objective Postoperative amnesia after surgery for anterior communicating artery aneurysm might be associated with the damage of the basal forebrain. Our purpose was to verify whether decreased regional cerebral blood flow (rCBF) in basal forebrain could be related to the degree of postoperative amnesia. Methods Regional voxel rCBF data analyzed using three-dimensional stereotactic surface projection on 123I-IMP-SPECT were compared between ten patients with postoperative amnesia and 13 normal subjects. The Severity (average Z score of the voxels with a Z score that exceeds a threshold value of 2) was calculated. The cerebral lobes with rCBF exhibiting Severity > 2 in all patients were identified. In these lobes, we then examined whether there was a gyrus exhibiting Severity that was negatively related to memory quotients (MQs). Results In the right subcallosal gyrus, there was a significant negative correlation between Severity and visual MQ (ρ= − 0.884, p = 0.0007) or general MQ (ρ =− 0.853, p = 0.0017). In the right anterior cingulate gyrus, there was a significant negative correlation between Severity and verbal MQ (ρ = − 0.769, p = 0.0092). In the right rectal gyrus, there was a significant negative correlation between Severity and general MQ (ρ = − 0.811, p = 0.0044). No significant correlations were found between Severity in other brain regions and verbal, visual, or general MQ. Conclusions The decreased rCBF in the subcallosal gyrus included in the basal forebrain, anterior cingulate gyrus, and the rectal gyrus in the right hemisphere was related to postoperative amnesia. Electronic supplementary material The online version of this article (10.1007/s12149-020-01436-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Hirokazu Kikuchi
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Shoki Takahashi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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18
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Michel P, Finet P, Goffette P, Raftopoulos C. Bilateral Fornical Columns Infarction Secondary to an Arteriovenous Malformation Embolization. World Neurosurg 2019; 135:113-117. [PMID: 31790837 DOI: 10.1016/j.wneu.2019.11.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Three group of perforation branches are described coming out from the anterior communicating artery (AcoA): the hypothalamic branches, chiasmatic branches, and subcallosal artery (ScA). Bilateral anterior fornix infarction with sudden anterograde amnesia after ScA ischemic stroke has been previously described. Although only a few cases are reported in the literature, ScA occlusion has been well described for both noniatrogenic and iatrogenic causes. Several cases of iatrogenic injuries have been reported after AcoA aneurysm clipping or, less frequently, after embolization. CASE DESCRIPTION A 43-year-old man was admitted for a subarachnoid hemorrhage secondary to the rupture of a right high-flow anterior cerebral artery (ACA) aneurysm related to a right frontobasal arteriovenous malformation (AVM). The aneurysm was treated early by endovascular embolization. At discharge, the patient was Glasgow Outcome Scale score 1. Five months later, the AVM was treated endovascularly in 3 sessions. The last session was performed through a median branch of the right A2 segment of the ACA, allowing an 80% AVM exclusion. However, the patient woke up with anterograde memory impairment and confusion. Magnetic resonance imaging showed infarction of both anterior columns of the fornix. The clinical condition of the patient 3 years after stroke has improved. CONCLUSIONS Bilateral anterior fornix infarction leading to amnestic syndrome is encountered in ScA stroke. We report a rare case of bilateral anterior fornix infarction secondary to an AVM embolization supplied by the ACA, not an anatomic region that provides blood supply of the anterior columns of the fornix.
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Affiliation(s)
- Pauline Michel
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Patrice Finet
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Goffette
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Department of Interventional Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christian Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Najera E, Alves Belo JT, Truong HQ, Gardner PA, Fernandez-Miranda JC. Surgical Anatomy of the Subcallosal Artery: Implications for Transcranial and Endoscopic Endonasal Surgery in the Suprachiasmatic Region. Oper Neurosurg (Hagerstown) 2019; 17:79-87. [PMID: 30561716 DOI: 10.1093/ons/opy276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suprachiasmatic subcallosal lesions may have an intimate relationship with the anterior communicating artery (AcomA); injury to AcomA branches can result in basal forebrain infarction and cognitive dysfunction. OBJECTIVE To evaluate anatomic variations of the AcomA basal perforating branches, especially the subcallosal artery (ScA), for clinical implications when approaching the suprachiasmatic subcallosal region from endonasal and transcranial routes. METHODS The origin, course, diameter, and branching pattern of the AcomA's perforating branches were studied in 33 specimens from transcranial and endonasal perspectives. RESULTS The ScA was present in 79% of the specimens as a single dominant artery arising from the posterior/posterosuperior surface of the AcomA, along with hypothalamic arteries (55%), or as a single artery (24%). It coursed posteriorly towards the lamina terminalis region, curving superiorly to the subcallosal area. The ScA gave off many branches to provide the main blood supply to the subcallosal region. Importantly, it supplies the septal/subcallosal region bilaterally. The ScA can be found posterior, superior, or inferior to the AcomA when using a transylvian, interhemispheric, or endonasal approach, respectively. In specimens with no ScA (21%), the median callosal artery (MdCA) was the dominant artery arising from the AcomA. It followed an identical course to the ScA, providing supply to the same structures bilaterally, but its distal extension reached the body/splenium of the corpus callosum. The MdCA is a ScA variant. CONCLUSION The ScA is a unique vessel because it supplies the septal/subcallosal region bilaterally; preservation of this vessel during surgery is crucial for successful outcomes.
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Affiliation(s)
- Edinson Najera
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joao T Alves Belo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Huy Q Truong
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Chenin L, Kaoudi A, Foulon P, Havet E, Peltier J. Microsurgical anatomy of the subcallosal artery. Surg Radiol Anat 2019; 41:1037-1044. [DOI: 10.1007/s00276-019-02279-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
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Xu SY, Xi FC, Wu XW, Li CX. Ischemic stroke in the combined territories of the septum pellucidum and the cingulate gyrus: A case report and literature review. Medicine (Baltimore) 2019; 98:e15879. [PMID: 31169694 PMCID: PMC6571270 DOI: 10.1097/md.0000000000015879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cases of isolated septum pellucidum infarction have not yet been reported. To date, there are only 2 stroke reports involving septum pellucidum infarction. The etiology of septum pellucidum infarction was subcallosal artery (ScA) injury. The abnormalities were strictly confined to the septum pellucidum and the right cingulated gyrus, making this the first case to report such confined abnormalities. PATIENT CONCERNS In this report, we present a case of ischemic stroke confined to the septum pellucidum and cingulated gyrus in a 48-year-old male patient who presented with transient ischemic attack-like paroxysmal lower left limb weakness. DIAGNOSIS Even no obvious abnormalities were revealed by an emergency computed tomography, the infarction in the combined territories of the septum pellucidum and the cingulate gyrus was detected on magnetic resonance imaging. INTERVENTIONS Aspirin with clopidogrel was administered for 3 weeks as a secondary preventive drug. Clopidogrel was selected as a long-term antiplatelet drug based on a thromboelastogram. OUTCOMES The patient showed no positive signs related to the nervous system in the hospital, and there was no recurrence during the 3-month follow-up. CONCLUSIONS Infarction in the septum pellucidum and cingulate gyrus is rare and has atypical clinical manifestations. Physical examination may not yield obvious positive signs. False-negative computed tomography findings of the head may result in misdiagnosis. Thus, it is necessary to perform whole-brain magnetic resonance imaging in time. Moreover, ScA protection should be paid attention to during surgery for anterior communicating artery aneurysm.
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Affiliation(s)
- Sui-Yi Xu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Fu-Chun Xi
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Xiao-Wei Wu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Chang-Xin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
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22
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Anterior communicating artery division in the endoscopic endonasal translamina terminalis approach to the third ventricle: an anatomical feasibility study. Acta Neurochir (Wien) 2019; 161:811-820. [PMID: 30430257 DOI: 10.1007/s00701-018-3709-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Endonasal endoscopic approaches (EEA) to the third ventricle are well described but generally use an infrachiasmatic route since the suprachiasmatic translamina terminalis corridor is blocked by the anterior communicating artery (AComA). The bifrontal basal interhemispheric translamina terminalis approach has been facilitated with transection of the AComA. The aim of the study is to describe the anatomical feasibility and limitations of the EEA translamina terminalis approach to the third ventricle augmented with AComA surgical ligation. METHODS Endoscopic dissections were performed on five cadaveric heads injected with colored latex using rod lens endoscopes attached to a high-definition camera and a digital video recorder system. A stepwise anatomical dissection of the endoscopic endonasal transtuberculum, transplanum, translamina terminalis approach to the third ventricle was performed. Measurements were performed before and after AComA elevation and transection using a millimeter flexible caliper. RESULTS Multiple comparison statistical analysis revealed a statistically significant difference in vertical exposure between the control condition and after AComA elevation, between the control condition and after AComA division and between the AComA elevation and division (p < 0.05). The mean difference in exposed surgical area was statistically significant between the control and after AComA division and between elevation and AComA division (p < 0.01), whereas it was not statistically significant between the control condition and AComA elevation (NS). CONCLUSION The anatomical feasibility of clipping and dividing the AComA through an EEA has been demonstrated in all the cadaveric specimens. The approach facilitates exposure of the suprachiasmatic optic recess within the third ventricle that may be a blind spot during an infrachiasmatic approach.
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23
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Time to Face the Nightmare That Has Plagued Neurosurgeons for Years: Memory Impairment from Postsurgery Subcallosal Artery Infarction for Anterior Communicating Artery Aneurysms. World Neurosurg 2019; 121:280-281. [PMID: 30557926 DOI: 10.1016/j.wneu.2018.08.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022]
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Takano Y, Tatewaki Y, Mutoh T, Ohara Y, Yamamoto S, Taki Y. Isolated Fornix Infarction with Damage to the Limbic System as a Cause of Persistent Amnesia: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1382-1385. [PMID: 30459298 PMCID: PMC6266538 DOI: 10.12659/ajcr.912508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 54 Final Diagnosis: Cerebral infarction Symptoms: Amnesia Medication: — Clinical Procedure: MRI (magnetic resonance imaging) Specialty: Neurology
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Affiliation(s)
- Yumi Takano
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Yasuko Tatewaki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Yamato Ohara
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Shuzo Yamamoto
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
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25
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Azevedo Kauppila L, Nascimento Alves P, Reimão S, Fonseca AC, Pinho E Melo T, Martins IP. Memory impairment due to bilateral fornix infarction: Characterisation and follow-up. J Neurol Sci 2018; 390:10-13. [PMID: 29801866 DOI: 10.1016/j.jns.2018.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Linda Azevedo Kauppila
- Stroke Unit, Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHLN, Lisbon.
| | - Pedro Nascimento Alves
- Stroke Unit, Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHLN, Lisbon; Language Research Laboratory, Faculty of Medicine, University of Lisbon
| | - Sofia Reimão
- Neuroradiology Department, Hospital Santa Maria, CHLN, Lisbon
| | - Ana Catarina Fonseca
- Stroke Unit, Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHLN, Lisbon
| | - Teresa Pinho E Melo
- Stroke Unit, Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHLN, Lisbon
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26
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The goblet sign in the amnestic syndrome of the subcallosal artery infarct. Neurol Sci 2018; 39:1463-1465. [DOI: 10.1007/s10072-018-3425-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
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27
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Ren C, Yuan J, Tong S, Xue Y, Wu H, Li W, Wang J, Sun Z, Gong L, Wang X, Liu J, Chen Q, Liu H. Memory Impairment Due to a Small Acute Infarction of the Columns of the Fornix. J Stroke Cerebrovasc Dis 2018; 27:e138-e143. [PMID: 29571757 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Clinically infarction of the columns of the fornix is very rare. It is also easy to be overlooked during imaging examination due to the special anatomical localization and features of columns of the fornix. In the meantime, with memory disorder to be its most prominent manifestation, it is very easily false diagnosed as other diseases when the lesion focus is overlooked, causing unnecessary invasive examinations like cerebrospinal fluid tests. METHODS Case report and Literature review. RESULTS We presented a 66-year-old woman with memory impairment due to a small acute infarction of the columns of the fornix. Through her diagnosis and treatment, we believed that early diagnosis and treatment were important to these patients who were enduring the disease. In addition, literature review informed us that for those unwilling to undergo cerebral angiography or for small cerebrovascular lesions that cannot be detected by angiography, 7T magnetic resonance imaging (MRI) might be an ideal diagnostic method. CONCLUSION This case illustrated the significance of MRI in diagnosis for patients with acute memory impairment. When reading MRI results, one needs to pay attention to identify small lesions at special locations. In addition, cerebral apoplexy is still the first consideration of diagnosis when acute memory impairment occurs in patients with cerebrovascular disease risk factors.
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Affiliation(s)
- Chao Ren
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jiaxin Yuan
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Shuyan Tong
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yingxia Xue
- Department of Neurology, Penglai Traditional Chinese Medicine Hospital in Shandong Province, Penglai, China
| | - Hongliang Wu
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Wenjuan Li
- Radiology department, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jiahui Wang
- Central Laboratory, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zhongwen Sun
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Li Gong
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaotong Wang
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jie Liu
- Neurosurgical Intensive Care Unit, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
| | - Qi Chen
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
| | - Hong Liu
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
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Salvalaggio A, Cagnin A, Nardetto L, Manara R, Briani C. Acute amnestic syndrome in isolated bilateral fornix stroke. Eur J Neurol 2018; 25:787-789. [PMID: 29427459 DOI: 10.1111/ene.13592] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Acute onset of amnestic syndrome may represent a challenging diagnostic issue. In addition to non-vascular etiology, thalamic strokes or infarction involving several temporal lobe structures have been reported. METHODS We describe three patients in whom an isolated bilateral anterior fornix infarction presented with an acute amnestic syndrome. Clinical presentation, differential diagnosis and magnetic resonance images are discussed for each patient and vascular anatomy of the involved brain regions is also considered. RESULTS Bilateral anterior columns of the fornix showed cytotoxic edema and bilateral narrowing of anterior cerebral artery was demonstrated. CONCLUSIONS We suggest that bilateral fornix infarction should always be considered in the diagnostic work-up of an amnestic syndrome with acute onset.
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Affiliation(s)
- A Salvalaggio
- Department of Neurosciences (DNS), University of Padova, Padova
| | - A Cagnin
- Department of Neurosciences (DNS), University of Padova, Padova.,IRCCS San Camillo Hospital, Venice
| | | | - R Manara
- Neuroradiology. Sezione di Neuroscienze, University of Salerno, Salerno, Italy
| | - C Briani
- Department of Neurosciences (DNS), University of Padova, Padova
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Noda K, Ota N, Saito N, Takeda R, Tokuda S, Tanikawa R. Impacts of a Size Ratio on Outcome in Patients with Surgically Treated Unruptured Nondissecting Anterior Cerebral Artery Aneurysms. World Neurosurg 2018; 111:e250-e260. [DOI: 10.1016/j.wneu.2017.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
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30
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Wang J, Ke J, Zhou C, Yin C. Amnesia due to the Injury of Papez Circuit Following Isolated Fornix Column Infarction. J Stroke Cerebrovasc Dis 2018; 27:1431-1433. [PMID: 29395646 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/18/2017] [Accepted: 12/23/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jianping Wang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China.
| | - Junji Ke
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Chenguang Zhou
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Chunmao Yin
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
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31
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Mugikura S, Takahashi S. Letter by Mugikura and Takahashi Regarding Article, “Ischemic Amnesia: Causes and Outcome”. Stroke 2018; 49:e14. [DOI: 10.1161/strokeaha.117.019366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shunji Mugikura
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shoki Takahashi
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Sendai, Japan
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32
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Chaddad-Neto F, Devanir Silva da Costa M, Bozkurt B, Leonardo Doria-Netto H, de Araujo Paz D, da Silva Centeno R, Grande AW, Cavalheiro S, Yağmurlu K, Spetzler RF, Preul MC. Contralateral anterior interhemispheric-transcallosal-transrostral approach to the subcallosal region: a novel surgical technique. J Neurosurg 2017; 129:508-514. [PMID: 29099298 DOI: 10.3171/2017.4.jns16951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The authors report a novel surgical route from a superior anatomical aspect-the contralateral anterior interhemispheric-transcallosal-transrostral approach-to a lesion located in the subcallosal region. The neurosurgical approach to the subcallosal region is challenging due to its deep location and close relationship with important vascular structures. Anterior and inferior routes to the subcallosal region have been described but risk damaging the branches of the anterior cerebral artery. METHODS Three formalin-fixed and silicone-injected adult cadaveric heads were studied to demonstrate the relationships between the transventricular surgical approach and the subcallosal region. The surgical, clinical, and radiological history of a 39-year-old man with a subcallosal cavernous malformation was retrospectively used to document the neurological examination and radiographic parameters of such a case. RESULTS The contralateral anterior interhemispheric-transcallosal-transrostral approach provides access to the subcallosal area that also includes the inferior portion of the pericallosal cistern, lamina terminalis cistern, the paraterminal and paraolfactory gyri, and the anterior surface of the optic chiasm. The approach avoids the neurocritical perforating branches of the anterior communicating artery. CONCLUSIONS The contralateral anterior interhemispheric-transcallosal-transrostral approach may be an alternative route to subcallosal area lesions, with less risk to the branches of the anterior cerebral artery, particularly the anterior communicating artery perforators.
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Affiliation(s)
- Feres Chaddad-Neto
- 1Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | - Baran Bozkurt
- 2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota; and
| | | | | | | | - Andrew W Grande
- 2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota; and
| | - Sergio Cavalheiro
- 1Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Kaan Yağmurlu
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Spetzler
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Isolated Subcallosal Artery Infarction Secondary to Localized Cerebral Vasospasm of Anterior Communicating Artery Complex Following Subarachnoid Hemorrhage. World Neurosurg 2017; 107:1043.e15-1043.e18. [DOI: 10.1016/j.wneu.2017.07.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022]
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Teramoto S, Bertalanffy H. Predicting the necessity of anterior communicating artery division in the bifrontal basal interhemispheric approach. Acta Neurochir (Wien) 2016; 158:1701-8. [PMID: 27334737 PMCID: PMC4980421 DOI: 10.1007/s00701-016-2884-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/15/2016] [Indexed: 11/29/2022]
Abstract
Background The anterior communicating artery (ACoA) often limits surgical exposure in the anterior interhemispheric approach. Although division of the ACoA has been proposed occasionally, it is rarely practiced, and criteria for such a surgical maneuver remain unknown. Our purpose was to identify key factors that allow for predicting the necessity of controlled ACoA division in the bifrontal basal interhemispheric approach. Method Twenty-two consecutive patients who underwent surgery via the bifrontal basal interhemispheric approach for removal of various pathologic brain lesions were examined. First, tumors were dichotomized into central and lateral lesions. Next, three tumor parameters were compared between cases with and without ACoA division in each, the central and lateral lesion groups, respectively: tumor volume, tumor depth (defined as distance between the ACoA and posterior tumor margin) and tumor laterality angle (defined as the geometric angle between the lateral tumor margin and sagittal midline). Results Tumor volume was not related in a statistically significant manner to ACoA division in both the central (P = 0.06) and lateral (P = 0.13) lesion groups, respectively. However, tumor depth was significantly correlated with ACoA division in the central lesion group (P = 0.01), whereas in the lateral lesion group, the tumor laterality angle showed a significant correlation with ACoA division (P = 0.04). Conclusions Our results suggest that controlled ACoA division may be required in central lesions with a depth of 38 mm or more and in lateral lesions with an angle of 23 degrees or more as defined in this study. Two key factors were thus identified that may predict the necessity of controlled ACoA division before surgery.
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Affiliation(s)
- Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan.
| | - Helmut Bertalanffy
- International Neuroscience Institute Hannover, Rudolf-Pichlmayrstrasse 4, D-30625, Hannover, Germany
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Amnestic syndrome of the subcallosal artery with additional penetrating vessel involvement. J Neurol Sci 2015; 359:438-9. [DOI: 10.1016/j.jns.2015.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/17/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022]
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Microanatomy of the subcallosal artery: an in-vivo 7 T magnetic resonance angiography study. Eur Radiol 2015; 26:2908-14. [DOI: 10.1007/s00330-015-4117-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/23/2015] [Accepted: 11/12/2015] [Indexed: 01/13/2023]
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Lescher S, Zimmermann M, Konczalla J, Deller T, Porto L, Seifert V, Berkefeld J. Evaluation of the perforators of the anterior communicating artery (AComA) using routine cerebral 3D rotational angiography. J Neurointerv Surg 2015; 8:1061-6. [DOI: 10.1136/neurintsurg-2015-012049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/16/2015] [Indexed: 11/03/2022]
Abstract
BackgroundDamage to perforating branches of the anterior communicating artery (AComA) is a known complication of surgical or interventional treatment procedures for AComA aneurysm leading to neurologic deficits. In spite of the clinical relevance of these AComA branches, they have not been systematically analyzed using imaging techniques and most of our knowledge is based on post-mortem injection studies or neurosurgical reports. We therefore analyzed three-dimensional rotational angiography (3DRA) images of the AComA, and propose a first imaging definition of the microvascular structures surrounding the AComA.MethodsReconstructed 3D data derived from standard-of-care rotational angiography acquisitions (5 s DSA) were retrospectively analyzed. 20 patients undergoing selective cerebral angiography and 3DRA for therapy assessment were included in our study. 3DRA datasets were reconstructed and displayed using the volume rendering technique (VRT). Additionally, multiplanar reformatted CT-like cross-sectional images (MPR) were used to evaluate the number, size, and origin of the perforators of the AComA.ResultsPerforating branches of the AComA could be demonstrated in all cases with large interindividual variations in vessel visibility. MPRs appeared to be superior to total VRT volumes in the visualization of the perforating branches of the AComA.Conclusions3DRA can be used to visualize perforating branches of the AComA in vivo. Since damage to these perforators may result in neurologic deficits, visualization of these vessels prior to surgery or endovascular aneurysm treatment could help in the planning of therapeutic interventions. Further refinement of current imaging techniques will be necessary, however, to increase the reliability of small vessel angiography.
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Mugikura S, Takahashi S. Fornix Infarction due to Involvement of Posterior Circulation. J Stroke Cerebrovasc Dis 2015; 24:2883-5. [PMID: 26338108 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Shoki Takahashi
- Department of Diagnostic Radiology, Tohoku University, Graduate School of Medicine, Sendai, Japan
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Infarction in the pars libera of the column of fornix including pre (cholinergic)- and post (circuit of Papez fiber tracts)-commissural fibers causes "basal forebrain" amnesia. Neuroradiology 2015; 57:757-9. [PMID: 25732199 PMCID: PMC4495264 DOI: 10.1007/s00234-015-1504-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/20/2015] [Indexed: 11/13/2022]
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Mortimer AM, Steinfort B, Faulder K, Erho T, Scherman DB, Rao PJ, Harrington T. Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms. J Neurointerv Surg 2015; 8:256-64. [DOI: 10.1136/neurintsurg-2014-011620] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/09/2015] [Indexed: 11/04/2022]
Abstract
BackgroundSurgical clipping and endovascular coiling yield similar functional outcomes for the treatment of saccular aneurysms of the anterior communicating (ACOM) artery. However, surgical treatment may be associated with greater rates of cognitive impairment due to injury of adjacent structures. We aimed to quantify the rates of injury (infarction/hemorrhage) for both clipping and coiling of ACOM aneurysms.MethodsThis was a retrospective dual-center radiological investigation of a consecutive series of patients with ruptured and unruptured ACOM aneurysms treated between January 2011 and October 2014. Post-treatment CT or MRI was assessed for new ischemic or hemorrhagic injury. Injury relating to the primary hemorrhage or vasospasm was differentiated. Univariate analysis using χ2 tests and multivariate analysis using binary logistic regression was used.Results66 patients treated with clipping were compared with 93 patients treated with coiling. 32/66 (48.5%) patients in the clipping group suffered treatment-related injury (31 ischemic, 1 hemorrhagic) compared with 4/93 (4.4%) patients in the coiling group (3 ischemic, 1 hemorrhagic) (p<0.0001). For patients with subarachnoid hemorrhage, the multivariate OR for infarction for clipping over coiling was 24.42 (95% CI 5.84 to 102.14), p<0.0001. The most common site of infarction was the basal forebrain (28/66 patients, 42.4%), with bilateral infarction in 4. There was injury of the septal/subcallosal region in 12/66 patients (18%).ConclusionsClipping of ACOM aneurysms is associated with significantly higher rates of structural injury than coiling, and this may be a reason for superior cognitive outcomes in patients treated with coiling in previously published studies.
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