Topographic disorientation following mesial left temporo-occipital hemorrhage

Abstract

A 52-year-old left-handed man with a history of uncontrolled hypertension presented complaining of “memory problems.” Further description of his symptoms, however, revealed relatively isolated dysfunction in finding his way around previously known routes (audio clip at neurology.org/cp), despite recognition of landmarks. This was sudden in onset and nonprogressive. Formal neuropsychological testing revealed moderate impairment in verbal greater than visual memory, with additional impairments on tasks of working memory, processing speed, mental flexibility, and phonemic word fluency. Color naming and face recognition were normal. Brain MRI showed a mesial left temporo-occipital hemorrhage with extension into the left parahippocampal region (figure, A and B). Multiple subcortical T2 and fluid-attenuated inversion recovery hyperintensities were also evident (figure, B). Gradient-echo revealed multiple areas of hemosiderin, evidence of microbleeds (figure, C). A diagnosis of topographic disorientation due to mesial left temporal hemorrhage was made.