Capsular Genu Infarction Presenting with Confusional Syndrome : An Analysis of Clinical and Neuroradiologic Findings

J Korean Neurol Assoc > Volume 14(2); 1996 > Article

Journal of the Korean Neurological Association 1996;14(2): 371-381.

착란을 증상으로 한 내포-슬부 경색(Capsular-Genu Infarction)의 임상 양상에 대한 연구

하정호, 김종성, 이재홍, 이명종

울산대학교 의과대학 서울중앙병원 신경과학교실

Capsular Genu Infarction Presenting with Confusional Syndrome : An Analysis of Clinical and Neuroradiologic Findings

Jeong-Ho Ha, M.D., Jong-Sung Kim, M.D., Jae-Hong Lee, M.D., Myoung-Chong Lee, M.D.

Department of Neurology and Oncol*, Ulsan University College of Medicine, Asan Medical Center

Abstract

We reviewed 5 patients with infarcts involving the genu of the internal capsule, who revealed behavioral changes and cognitive defects. They developed an acute confusion and/or dementic feature along with other behavioral changes characterized by apathy, hypersomnia, memory impairment, and cognitive impairment, mimicking frontal lobe dysfunction. Brain MRI and/or CT scan localized the lesion to the genu of the internal capsule. Brain perfusion SPECT performed in 3 patients showed hypoperfusion in ipsilateral cerebral hemisphere. Two mechanisms are suggested to explain the development of confusion or dementia after capsular genu infarct . (I) a disconnection or diaschisis of thalamo-cortical interconnection (ii) selective neuronal loss of cerebral cortex due to chronic MCA or ICA occlusion with insufficient collateral blood flow. We suggest that capsular-genu infarction as a cause of acute confusion or dementia must be included in differential diagnosis.