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Departments of Neurology (Drs. Tatemichi, Desmond, Prohovnik, Gropen, Mohr, and Stern), Psychiatry (Drs. Prohovnik, Gropen, and Stern), and Radiology (Drs. Cross and Prohovnik), Columbia-Presbyterian Medical Center, New York, NY.
We examined six patients with an abrupt change in behavior after infarction involving the inferior genu of the internal capsule. The acute syndrome featured fluctuating alertness, inattention, memory loss, apathy, abulia, and psychomotor retardation, suggesting frontal lobe dysfunction. Contralateral hemiparesis and dysarthria were generally mild, except when the infarct extended into the posterior limb. Neuropsychological testing in five patients with left-sided infarcts revealed severe verbal memory loss. Additional cognitive deficits consistent with dementia occurred in four patients. A right-sided infarct caused transient impairment in visuospatial memory. Functional brain imaging in three patients showed a focal reduction in hemispheric perfusion most prominent in the ipsilateral inferior and medial frontal cortex. We infer that the capsular genu infarct interrupted the inferior and anterior thalamic peduncles, resulting in functional deactivation of the ipsilateral frontal cortex. These observations suggest that one mechanism for cognitive deterioration from a lacunar infarct is thalamocortical disconnection of white-matter tracts, in some instances leading to "strategic-infarct dementia."
Address correspondence and reprint requests to Dr. T.K. Tatemichi, Stroke and Aging Research Project, Neurological Institute, 710 West 168th Street, New York, NY 10032.
Supported in part by Grants NS26179 and AG05433 from the National Institutes of Health.
Presented in part at the Second European Stroke Conference, Lausanne, Switzerland, June 1992.
Received January 23, 1992. Accepted for publication in final form March 12, 1992.
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