Ricardo Barojas-Alvarez Manuel, Mariana Longoria-Ibarrola Erika, Al Sosa-Ortiz, Manuel Calleja-Castillo Juan, Jesus Ramirez-Bermudez
Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Dementia Laboratory, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Cereb Circ Cogn Behav. 2021 Jun 30;2:100023. doi: 10.1016/j.cccb.2021.100023. eCollection 2021.
We report the case of a patient with ruptured middle cerebral artery aneurysm, subarachnoid hemorrhage and frontal intracerebral hemorrhage, who secondarily presented with delayed cerebral ischemia and bilateral occipital infarcts, with complete vision loss, visual anosognosia, and confabulations as the main symptoms. Additionally, the patient had defined features of Cotard syndrome, as revealed by persistent nihilistic delusions. The brain imaging studies showed a bilateral occipital ischemic lesion, as well as frontal and parietal hemorrhagic lesions in the right hemisphere. We address the general theories of anosognosia, confabulation and the problem of why a bilateral occipital lesion is not enough for these metacognitive defects to exist. The presence of right frontal and or parietal hemisphere lesions could be necessary features in most cases.
我们报告了一例大脑中动脉动脉瘤破裂、蛛网膜下腔出血和额叶脑出血的患者，该患者继发出现迟发性脑缺血和双侧枕叶梗死，主要症状为完全失明、视觉失认症和虚构症。此外，该患者具有科塔尔综合征的明确特征，表现为持续的虚无妄想。脑部影像学研究显示双侧枕叶缺血性病变，以及右半球额叶和顶叶出血性病变。我们探讨了失认症、虚构症的一般理论，以及为何双侧枕叶病变不足以导致这些元认知缺陷的问题。在大多数情况下，右侧额叶和/或顶叶半球病变的存在可能是必要特征。
