Restricted Left Gyrus Rectus Hemorrhage with Unusual Frontal Syndrome Presentation

Abstract

and collaborating patient with a Glasgow Coma Scale of 14/15 and no neurological deficit or lateralizing signs. The brain CT scan showed a left inferior frontal sub-arachnoid hemorrhage secondary to an aneurysm rupture from the distal left ca-rotid artery bifurcation (M1; grade: Fisch-er IV, HH3, WFNS2), spread to both syl-vian fissures and in the perimesencephalic cistern, which was associated with a left GR parenchymatous hemorrhage. She was treated by cerebral arteriography with em-bolization of the aneurysm by placement of 3 Guglielmi detachable coils, with an ex-cellent result. There were no complications following this procedure. A bedside neuropsychological assess-ment performed 6 days after symptom on-set showed a preserved orientation to time, place, and person, fluent and informative spontaneous oral expression, very slight word-finding difficulties (Boston Naming Test 15/34) and impairment of verbal cate-gory-specific and literal fluency, maxi-mum name of animals (5) and a word be-ginning with M (3) in 1 min, but preserved comprehension (complex command 4 out of 4 correctly executed). There were also slight verbal memory deficits, and a major behavioral slowdown with lack of initia-tive in action and in language that impact-ed on other cognitive functions as oral cal-culation (prolonged thinking time, loss of her train of thought in the course of calcu- De, r Si ar The study of localized and well-cir-cumscribed brain lesions has contributed greatly to our understanding of the func-tion of single brain areas. The gyrus rectus (GR) is part of Brodmann’s area (BA) 11, which together with BA 10 and BA 47 form the orbito-frontal cortex. Lesions of this region are classically associated with dis-inhibition syndromes even if some reports described very few or no behavioral symp-toms after such lesions [1–3] . Here we re-port the case of a 59-year-old woman who suffered a subarachnoid hemorrhage asso-ciated with a restricted lesion of her left GR, with an unusual frontal syndrome presentation.