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Abstract
BackgroundTo evaluate systematically the cognitive deficits following posterior cerebral artery (PCA) strokes, especially agnosic visual disorders, and to study anatomical-clinical correlations.Methods and FindingsWe investigated 31 patients at the chronic stage (mean duration of 29.1 months post infarct) with standardized cognitive tests. New experimental tests were used to assess visual impairments for words, faces, houses, and objects. Forty-one healthy subjects participated as controls. Brain lesions were normalized, combined, and related to occipitotemporal areas responsive to specific visual categories, including words (VWFA), faces (FFA and OFA), houses (PPA) and common objects (LOC). Lesions were located in the left hemisphere in 15 patients, in the right in 13, and bilaterally in 3. Visual field defects were found in 23 patients. Twenty patients had a visual disorder in at least one of the experimental tests (9 with faces, 10 with houses, 7 with phones, 3 with words). Six patients had a deficit just for a single category of stimulus. The regions of maximum overlap of brain lesions associated with a deficit for a given category of stimuli were contiguous to the peaks of the corresponding functional areas as identified in normal subjects. However, the strength of anatomical-clinical correlations was greater for words than for faces or houses, probably due to the stronger lateralization of the VWFA, as compared to the FFA or the PPA.ConclusionsAgnosic visual disorders following PCA infarcts are more frequent than previously reported. Dedicated batteries of tests, such as those developed here, are required to identify such deficits, which may escape clinical notice. The spatial relationships of lesions and of regions activated in normal subjects predict the nature of the deficits, although individual variability and bilaterally represented systems may blur those correlations.
Highlights
Strokes in the territory of the posterior cerebral artery (PCA) constitute about J of brain infarcts [1]
The spatial relationships of lesions and of regions activated in normal subjects predict the nature of the deficits, individual variability and bilaterally represented systems may blur those correlations
Category specific agnosias are reported: prosopagnosia occurs in 5.5% of cases at most [6] and pure alexia in 16% of cases [3]
Summary
Strokes in the territory of the posterior cerebral artery (PCA) constitute about J of brain infarcts [1]. The range of clinical symptoms has been reported in several large series of patients but deficits were generally not assessed using systematic neuropsychological batteries [1,2,3,4,5,6,7]. Often mentioned without further details, is much less frequent, ranging from 0% [1] to 3% [5]. This rate may rise to 8.5% in isolated infarctions of the superficial territory of the PCA [6]. To evaluate systematically the cognitive deficits following posterior cerebral artery (PCA) strokes, especially agnosic visual disorders, and to study anatomical-clinical correlations
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