The Japanese journal of neuropsychology

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ArticleTitle	The neuropsychology of stroke
Language	J
AuthorList	Koichi Tagawa MD
Affiliation	Haradoi Hospital, Center for Higher Brain Dysfunction
Publication	Japanese Journal of Neuropsychology: 20 (3), 185-194, 2004
Received
Accepted
Abstract	Neuropsychological manifestations of stroke are extremely variable. They vary depending on the site and extent of the stroke. However, clinical categories of stroke include various cerebral vasvcular abnormalities, ranging from ischemic infarction to hemorrahge. The pathopysiology of stroke and the pathomechanisms producing neuropsychological manifestations are discussed in this paper. 1. The pathopysiology is different between brain infarction and intracranial bleeding. In brain infarction, embolic infarct and thrombotic infarct show different features. Also in intracranial bleeding, hypertensive brain hemorrhage is different from subarachnoid hemorrhage in its pathophysiology. 2. The most common cause of aphasia is the brain infarction in the territory of the left middle cerebral artery. Typical aphasic syndromes, such as motor and sensory aphasia are observed in embolic occlusion. On the other hand, transcortical aphasia is produced by thrombotic occlusion of the main trunk of the carotid system as borderzone infarction. Total apasia appears in either emobolic or thrombotic infarction. In the latter, the infarcted area, shown with CT or MRI images, is restricted to the deep white matter. It is deep boderzone infarction. The area of reduced cerebral flow and metabolism obtained by PET or SPECT is more extensive than infarcted area shown with CT or MRI. 3. In the neuropsychological diagnosis of brain infarction, we have to take into consideration cerebaral artery occlusion syndrome. The middle cerebral artery supplies blood to the frontal, temporal and parietal lobe in the cerebral hemisphere. In some cases, we can identify pure frontal, temporal or parietal syndrome. However, most cases consist various combinations, such as fronto-parietal, temporo-parietal or fronto-temporo-parietal. Cerebral localization is important, too. Neuropsychological manifestations are found on the left sided, right sided or on both sides of the brain.
Keywords	apoplexy, neuropsychology, aphasia, cerebral embolism, borderzone infarction