J Korean Neurol Assoc > Volume 21(3); 2003 > Article

Journal of the Korean Neurological Association 2003;21(3): 239-247.

전략적 뇌경색 치매:임상적 특징,뇌영상 및 신경심리학적 소견

박경원 , 하병립 차재관 김상호 강도영 김재우

동아대학교 의과대학 신경과학교실,핵의학교실

"Strategic Infarct Dementia: Clinical Features, Neuroimaging and Neuropsychological Findings"

Kyung Won Park

Department of Neurology, College of Medicine, Dong-A University

Abstract

"Background: Strategic infarct dementia (SID) is characterized by focal ischemic lesions involving specific sites that are critical for higher cortical functions. However, the mechanisms of SID are not well understood. We evaluated lesion sites, neuropsychiatric symptoms, neuroimaging and neuropsychological findings in patients with SID and have come up with suggestions of the mechanism behind SID. M e t h o d s: Eleven patients with SID according to the NINDS-AIREN criteria for vascular dementia were included. All patients were given a neurologic examination, brain MRI with MRA and brain perfusion SPECT using Tc-99m HMPAO. We evaluated neuropsychiatric symptoms and neuropsycho-logical status using a Korean-version of the Neuropsychiatric Inventory(K-NPI) and Seoul Neuropsychological Screening Battery.
Results: Various sites were responsible for SID; the thalamus (n=5), genu of internal capsule (n=2), temporooccipital lobe (n=2), medial temporal lobe (n=1), medial frontal lobe (n=1). The most common neuropsychi-atric symptom was apathy according to the K-NPI. Brain perfusion SPECT revealed ipsilateral cortical hypoperfusion, mainly in the frontal and temporal areas. In several cases, there were some degrees of cortical hypoperfusion in the con-tralateral areas of the lesion. On neuropsychological assessment, cognitive deficits on attention and frontal executive function were prominent. C o n c l u s I o n s: The thalamus, genu of internal capsule, and temporooccipital area were the most common sites responsible for SID. Based on the results that there were cortical hypoperfusion ipsilateral to sub-cortical strategic infarct and prominent cognitive deficits on attention and frontal executive function, it is suggested that disruption of the frontal-subcortical circuit may play an important role in patients with SID.Key Words: Vascular dementia, Cerebral infarction, MRI, SPECT, Neuropsychological test"