London, United Kingdom 2013 8 Interesting and challenging cases Capgras syndrome after a left middle cerebral artery territory stroke H. G. Shetty1, Q. T. Anjum2 University Hospital of Wales, Cardiff, UNITED KINGDOM1, University Hospital of Wales, Car-diff, E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 271 UNITED KINGDOM2 Background: Capgras syndrome, in which one or several persons are perceived by the patient to be replaced by an identical imposter, has been reported with neurodegenerative diseases, stroke, head injury, drug misuse & other conditions. In such patients, previous studies have predominantly found temporal and right fronto-parietal cortex lesions. Ischaemic strokes have often been reported in the posterior area of the right hemisphere. Damage to the connections from face-processing areas in the right temporal lobe to the limbic system is believed to be the cause of this syndrome. We describe a patient with left hemispheric stroke who developed Capgras syndrome, which resolved completely in a few weeks. Case report: An 87 year old lady was admitted with mild right sided weakness and nominal aphasia. CT head scan showed a left medial parietal infarct & subcortical small vessel disease.Her memo-ry and cognitive state had declined gradually over previous few years. About a year earlier she had become very unpleasant to her son & grand son (although she recognized them), but had a good re-lationship with her daughter-in-law & other female family members. Her dysphasia and right sided weakness resolved gradually around next two weeks after admission. Initially after the stroke, she was subdued, very irritable & confused. She believed her son was an imposter & was distressed that ‘the person’ looked like her son but she knew that it was not her son. She was given cognitive-be-havioural therapy & commenced on Quetiapine & also on Mirtazapine for low mood. Over the next 3-4 weeks the Capgras traits gradually resolved; she became less agitated, more cooperative & pleasant. At this stage, she was found to have mild cognitive impairment. Conclusion: We describe a reversible Capgras delusion in an elderly lady, with pre-existing cogni-tive impairment, following an ischaemic stroke. She was unusual in that her delusion arose follow-ing a left middle cerebral artery territory stroke. 7 Interesting and challenging cases Cerebellar Cognitive Affective Syndrome and Stroke I. N. Bhatti1, A. Blight2, P. Hall3, R. Clauss4, J. Scott-Taggart5 Royal Surrey County Hospital, Guildford, UNITED KINGDOM1, Royal Surrey County Hospi-tal, Guildford, UNITED KINGDOM2, Royal Surrey County Hospital, Guildford, UNITED KING-DOM3, Royal Surrey County Hospital, Guildford, UNITED KINGDOM4, Royal Surrey County Hospital, Guildford, UNITED KINGDOM5 Introduction: Cerebellar cognitive affective syndrome is a rare complication of cerebellar stroke. Al-though described in medical literature it is not well recognised in the clinical setting. In this case we describe the challenges in recognising the condition and how functional brain imaging can aid our understanding of the cognitive sequelae. Case: An 85-year-old lady presented with vomiting, lethargy and reduced mobility. Computed To-mography (CT) of the brain showed a low attenuation area in the left cerebellar region. Magnetic Resonance Imaging (MRI) confirmed a localised left cerebellar infarct with haemorrhagic trans-formation. No other structural or vascular abnormalities were identified. Clinical examination did not elicit any motor or co-ordination deficits. However the patient did not progress as expected and began to show signs of psychomotor retardation and cognitive impairment. There was no evidence of cognitive decline prior to admission. Psychiatric assessment revealed variability in affect, poor engagement with tasks and cognitive difficulties. Anti-depressant therapy improved the patient’s af-fect but memory and concentration remained impaired. The diagnosis of cerebellar cognitive affec-tive syndrome was suggested. Formal cognitive assessment highlighted problems with visuospatial and executive function, attention and sequencing, language fluency, abstraction and memory recall. Single-photon Emission Computed Tomography (SPECT) imaging showed decreased uptake in the left cerebellum and the inferior right parietal region indicating crossed cerebellar-cerebral diaschisis, which supports the diagnosis. Discussion: Cerebellar cognitive affective syndrome was first described in 1998; giving insight into the behavioural changes related to cerebellar injury. The importance of the cerebellum in co-ordi-nation of movement has long been established but it is not until relatively recently has its role in cognition and behaviour been more closely observed and studied. This case illustrates that cerebel-lar stroke can cause a number of complex deficits that are not solely confined to motor weakness or co-ordination.
Karger_ESC London_2013
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