The Japanese journal of neuropsychology

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ArticleTitle	The problems of clinical categories and mechanisms of stroke in neuropsychology
Language	J
AuthorList	Yoichiro Hashimoto
Affiliation	Department of Neurology, Kumamoto City Hospital
Publication	Japanese Journal of Neuropsychology: 16 (3), 179-184, 2000
Received
Accepted
Abstract	There are many controversies in neuropsychology from the point of view of clinical categories and mechanism of stroke. Lacunar brain infarction is caused by the occlusion of single perforating artery followed by lesion less than 15 mm. Lacunar strokes do not show consciousness disturbance, neuropsychological sign including aphasia, apraxia, agnosia, memory disturbance, and convulsion, monoparesis. The patients with neuropsychological sing are diagnosed as atherothrombotic or cardioembolic brain infarction. But thalamic infarctions sometimes show aphasia, memory disturbance, or rarely anosognosia. Donnan et al proposed classification of subcortical infarction, in which subcortical infarctions are composed of lacunar infarcts, striatocapsular infarcts, internal borderzone infarcts, anterior choroidal artery infarcts, thalamic infarcts, white matter medullary infarcts, extended large subcortical infarcts, and leukoaraiosis. In Cardioembolic brain infarctions, the prognosis of the aphasic patients due to larger infarction will be poor than smaller infarct. The other side, there are aphasic patients with poor prognosis due to smaller infarct as well as larger infarct in atherothrombotic infarctions. Global aphasia without hemiparesis has been said a sign of embolic encephalopathy, but we had a patient by thrombotic occlusion. In acute stage, neuropsychological symptoms and signs are needed for diagnosis and treatment for stroke, therefore we should search for neuropsychological sign in spite of the presence of consciousness disturbance in acute stage.
Keywords	neuropsychological sign, brain infarction, lacunar stroke, thalamic infarction, global aphasia without hemiparesis, atherothrombotic brain infarction, cardioembolic brain infarction, acute stage, speech therapist