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Annals of Physical and Rehabilitation Medicine
Volume 55, n° S1
page e200 (octobre 2012)
Doi : 10.1016/j.rehab.2012.07.508
Neuropsychologie (III) : communications Affichées / Neuropsychology (III): posters

Complexity of visual disorders after right posterior cerebral artery infarction: A case report
 

C. Chesnel , P. Sportouch, V. Luherne, M.A. Labeyrie, E. Houdart, A. Yelnik
Service de MPR, université Paris-Diderot, AP–HP, groupe hospitalier Saint-Louis, Lariboisière, F.-Widal, 200, rue du Faubourg-Saint-Denis, 75010 Paris, France 

Corresponding author.

Introduction .– Posterior cerebral artery (PCA) infarction can lead to multiple entangled visual disorders, well-known in middle cerebral artery (MCA) infarction. We present a case report.

Case report .– Visual disorders occurred after a right PCA infarction (atheromatous etiology) on Mr. D M, 63 years old on the 6th of March 2012. Previous history included a left superficial MCA infarction in 2008 (leading to an only aphasia spontaneously regressive). He was a right-handed Senegalese cleaning agent. He had lived in France for 40 years and had a good level in French, both reading and writing. Large damage on the right PCA territory (medial temporal lobe, occcipital lobe, parahippocampal gyrus, posterior part of the thalamus, splenium of the corpus callosum) and left pre-frontal gyrus sequel were found on the RMI.

On the 3rd of April 2012 (admission in the PRM department) the patient presented visual impairment disorders: massive clinical left hemianopsia and an atypical left visual neglect. As a matter of fact, peripersonal and extrapersonal neglect were pre-eminent and severe, while personal neglect was rather moderate and conceptual neglect was rather respected as the straight ahead perception. Neglect did not allow asserting the presence of visual agnosia or visuo-constructive apraxia although strongly suspected. The 2D and 3D conception of space was dramatically disrupted. Visual acuity was good. Anosognosia was evident. There were not sensory-motor, memory or language disorders except a slight speech disorder (pseudo- stammering). The FIM scored at 89/126.

Conclusion .– In this case report, the patient’s right PCA damage lead to more complicated clinical features that usually described: left hemianopsia, massive neglect, severe visuospatial analysis and probably visuo-constructive apraxia. The six-month evolution and the refined neuropsychological assessment will be detailed in the presentation.


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