Vascular cognitive impairment due to dilated perivascular spaces in putamen: Connections with the ventrolateral prefrontal cortex and neurological deficits

Abstract

AbstractBackgroundAnatomical studies in animals have described multiple striatal circuits and suggested that sub‐components of the striatum project to distinct cortical areas. Researchers that reconstructed tracts of the left and right putamen have shown ipsilateral projections to the primary motor area, primary somatosensory area, supplementary motor area, premotor area, cerebellum, thalamus and prefrontal cortex (specifically to the ventrolateral prefrontal cortex). The ventrolateral prefrontal cortex appears to have a specific role in spatial processing and memory retrieval.MethodCase report and analyses of MR Images (T1, T2 and Flair) of a patient presenting with vascular cognitive impairment due to dilated perivascular spaces in putamen bilaterally.ResultMale patient, 81 years‐old, right‐handed, with four years of formal education and high cerebrovascular risk. His cognitive complaints began twelve years ago, and worsened in the last two years (losing personal belongings inside his own house, sometimes forgetting names of well‐known persons, with word finding difficulties). He denied impairment in activities of daily living, was able to organize his home budget, take his medications and go to the market alone. Now, he is physically and intellectually active (walking, reading newspapers, and talking about Philosophy), and still drives cars. His CDR score is 0.5, and his MMSE score is 29 (with 3 points in evoked memory). Word List Memory Task (Immediate Recall):4/5/8 (intrusion of "vessel" in the first two lists); Evocation:6 (intrusion of "vessel"); Recognition:10; Verbal Fluency (Animals):20; Verbal Fluency (Fruits):9. MR (10/15/2018): mild supratentorial microangiopathy; encephalomalacia/gliosis in the vermis and the left cerebellar hemisphere; Fasekas = 1 / Scheltens = 1 (bilaterally); bilateral supratentorial dilated perivascular spaces, particularly in the putamen.ConclusionOur patient does not have dementia, regardless of more than ten years of cognitive impairment. Bilateral dilated perivascular spaces in the putamen may cause deficits in memory retrieval and spatial processing. Neuropsychological evaluations must consider specific areas of brain injury. Our patient has impaired memory retrieval (with false memories verified by constant intrusions in the Word List Memory Task), and the high occurrence of losing personal belongings inside his house can be due to difficulties in spatial processing (mental map of positions of items in space).