The Japanese journal of neuropsychology

[Vol.16 No.1 contents]

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ArticleTitle The problems of neuroradiological diagnosis in neuropsychology
Language J
AuthorList Koichi Tagawa*
Affiliation *Fukuoka higher brain function center, Nagao hospital
Publication Japanese Journal of Neuropsychology: 16 (1), 2-12, 2000
Abstract There are many controversies in neuropsychology from the point of view of neuroimaging. The problems are caused by many factors such as the inadequate selection of neuroradiological procedures, the unsuitable timing of examination and the imperfection of the plane setting, etc. I showed some cases with neuroradiological problems in this paper. 1) The case of prosopagnosia usually has bilateral occipital lesions. I described a patient whose left occipital lobe lesion was minimal and transient. 2) A patient with a right thalamic infarct who had mild sleep and memory disturbance had a lesion that was not found by routine CT scan. An overlapping scan of the thalamus revealed a small infarction. It is considered that the lesion was obscured by the fogging effect. 3) The left unilateral spatial agnosia may be produced by a posterior cerebral artery occlusion. The disturbance of the right posterior watershed area may cause left unilateral spatial agnosia. 4) The disturbance of the left posterior watershed area produces transcortical sensory aphasia. The middle cerebral artery occlusion or the posterior cerebral artery will produce the lesion of this area. I described 2 patients of transcortical sensory aphasia due to left posterior cerebral artery occlusion. 5) Transcortical mixed aphasia is caused by left deep border-zone infarction or superficial border-zone infarction of both anterior and posterior watershed areas. The case of deep border-zone infarction shows the low density area of deep white matter on CT scan. However, the area of reduced cerebral blood flow and metabolism was often large extending to the cortical area of the left middle cerebral artery. 6) The prognosis of the patient with pure alexia due to left posterior cerebral artery occlusion will be poor when he has latent left cerebral artery occlusion or carotid artery occlusion. 7) I experienced 4 cases with recurrent cerebral hemorrhage presenting worsened previous hemiparesis on the ipsilateral side of the new hematoma. Their old lesion was in the contralateral side of the new lesion. Although the lack of pyramidal tract disturbance in the new lesion is an important condition, the reduction of cerebral blood flow and metabolism in the old lesion caused by diaschisis or impairment of compensation function may be acting as producing factor.
Keywords brain imaging, prosopagnosia, unilateral spatial agnosia, aphasia, pure alexia

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