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Frontal Lobe Dysfunction in Unilateral Lenticulostriate Infarcts: Prominent Role of Cortical Lesions

Frontal Lobe Dysfunction in Unilateral Lenticulostriate Infarcts: Prominent Role of Cortical Lesions Abstract • Most studies on frontal lobe dysfunction (FLD) in patients with striatal lesions did not consider possible associated cortical lesions not seen on computed tomographic scans. To determine the possible role of such cortical lesions, we assessed FLD in 10 patients with unilateral lenticulostriate infarct on computed tomographic scans. Magnetic resonance imaging revealed an associated cortical infarct not seen on computed tomographic scans in four patients. Using a battery of neuropsychological tests sensitive to FLD, we found that (1) the crossed tapping test was the only FLD test significantly disturbed in patients with pure unilateral lenticulostriate infarcts, (2) FLD was only present in patients with associated cortical infarct, and (3) caudate lesions only account for the number of echopraxic errors in the crossed tapping test. We conclude that unilateral isolated lenticulostriate infarcts might not lead to FLD, even though they may disturb the development of strategies involved in motor procedural learning. References 1. McHugh PR, Folstein MF. Psychiatric syndromes of Huntington's chorea: a clinical and phenomenologic study . In: Benson DF, Blumer D, eds. Psychiatric Aspects of Neurologic Diseases . New York, NY: Grune & Stratton; 1975:281-290. 2. Butters N, Sax D, Montgomery K, Tarlow S. Comparison of the neuropsychological deficits associated with early and advanced Huntington's disease . Arch Neurol . 1978;35:585-589.Crossref 3. Caine E, Hunter H, Weingartner H, Ebert M. Huntington's dementia . Arch Gen Psychiatry . 1978;35:377-384.Crossref 4. Jason GW, Pajurkova EM, Suchowersky O, et al. Presymptomatic neuropsychological impairment in Huntington's disease . Arch Neurol . 1988;45:769-773.Crossref 5. Hayden MR, Martin W, Stoessl AJ, et al. Positron emission tomography in the early diagnosis of Huntington's disease . Neurology . 1986;36:888-895.Crossref 6. Kuhl D, Phelps M, Markam C, Metter J, Riege W, Winter J. Cerebral metabolism and atrophy in Huntington's disease determined by 18 FDG and CT scans . Ann Neurol . 1982;12:425-434.Crossref 7. Mazziotta JC, Wapenski J, Phelps M, et al. Striatal glucose utilization in Huntington's disease . Neurology . 1985;35( (suppl) ):109. 8. Phelps ME, Mazziotta JC. Positron emission tomography: human brain function and biochemistry . Science . 1985;288:799-809.Crossref 9. Weinberger D, Berman K, ladarola M, Driesen N, Zec F. Prefrontal cortical blood flow and cognitive function in Huntington's disease . J Neurol Neurosurg Psychiatry . 1988;51:94-104.Crossref 10. Bowen FP, Kameny M, Burns M, Yahr MD. Effects of levodopa treatment on concept formation . Neurology . 1976;25:701-704.Crossref 11. Saint Cyr A, Taylor A, Lang A. Procedural learning and neostriatal dysfunction in man . Brain . 1988;111:941-959.Crossref 12. Lichter D, Corbett A, Fitzgibbon G, et al. Cognitive and motor dysfunction in Parkinson's disease . Arch Neurol . 1988;45:854-860.Crossref 13. Taylor A, Saint Cyr J, Lang A. Frontal lobe dysfunction in Parkinson's disease . Brain . 1986;109:845-883.Crossref 14. Teuber HL, Battersby WS, Bender MB. Performance of complex visual tasks after cerebral lesions . J Nerv Ment Dis . 1951;114:413-419. 15. Fuster JM. The Prefrontal Cortex . 2nd ed. New York, NY: Raven Press; 1989. 16. Cambier J, Masson M, Viader F, Limodin J, Strube A. Le syndrome frontal de la paralysie supranucléaire progressive . Rev Neurol . 1985;141:528-536. 17. Maher ER, Smith EM, Lees AJ. Cognitive deficits in the Steele Richardson Oleszewski syndrome . J Neurol Neurosurg Psychiatry . 1985;48:1234-1239.Crossref 18. Pillon B, Dubois B, Lhermitte F, Agid Y. Heterogeneity of cognitive impairment in progressive supranuclear palsy, Parkinson's disease and Alzheimer's disease . Neurology . 1986;36:1179-1185.Crossref 19. D'Antona R, Baron JC, Samson Y, et al. Subcortical dementia: frontal cortex hypometabolism detected by positron emission tomography in patients with progressive supranuclear palsy . Brain . 1985;108:785-799.Crossref 20. Goffinet AM, De Voider AG, Gillain C, et al. Positron tomography demonstrates frontal lobe hypometabol ism in progressive supranuclear palsy . Ann Neurol . 1989;25:131-139.Crossref 21. Blin J, Baron JC, Dubois B, et al. PET study in progressive supranuclear palsy . Arch Neurol . 1990;47:747-752.Crossref 22. Leenders KL, Frackowiack RSJ, Leers AJ. Steele Richardson Olszeski syndrome: brain energy metabolism, blood flow and fluorodopa uptake measures by positron emission tomography . Brain . 1988;111:615-630.Crossref 23. Mendez M, Adams N, Lewandowski K. Neurobehavioural changes associated with caudate lesions . Neurology . 1989;39:349-354.Crossref 24. Cambier J, Elghozi D, Strube E. Hémorragie de la tête du noyau caudé gauche . Rev Neurol . 1979;135:763-774. 25. Caplan LR, Schmahmann J, Kase C, et al. Caudate infarcts . Arch Neurol . 1990;47:133-143.Crossref 26. Pedrazzi P, Bogousslavsky J, Regli F. Hématomes limités à la tête du noyau caudé . Rev Neurol . 1990;146:726-738. 27. Anderson S, Damasio H, Tranel D. Neuropsychological impairments associated with lesions caused by tumor or stroke . Arch Neurol . 1990;47:397-405.Crossref 28. Delpla P, Meyer E, Zatorre R, et al. Metabolic and neuropsychological correlates of periventricular lucencies . J Cereb Blood Flow Metab . 1990;9( (suppl 1) ):S569. 29. Levine R, Lagreze H, Dobkin J, Turski P. Large subcortical hemispheric infarctions . Arch Neurol . 1988;45:1074-1077.Crossref 30. Weiller C, Ringelstein B, Reiche W, Thron A, Buell U. The large striatocapsular infarct: a clinical and pathological entity . Arch Neurol . 1990;47:1085-1091.Crossref 31. Donnan G, Bladin P, Berkovic S, Longley W, Saling M. The stroke syndrome of striatocapsular infarction . Brain . 1991;114:51-70. 32. Damasio HA. CT guide to the identification of cerebral vascular territory . Arch Neurol . 1983;140:138-142.Crossref 33. Takahashi S, Goto K, Fukasawa H, Kawata Y, Uemura K, Suzuki K. CT of cerebral infarction along the distribution of the basal perforating arteries . Radiology . 1985;155:107-118.Crossref 34. Daniels D, Haughton V, Naidich T. Cranial and Spinal Magnetic Resonance Imaging . New York, NY: Raven Press; 1987. 35. Fazekas F, Chawluk JB, Alavi A, Hurtig Ml, Zimmerman RA. MR signal abnormality at 1.5 T in Alzheimer dementia and normal aging . AJNR Am J Neuroradiol . 1987;8:421-426. 36. Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory . Neuropsychologia . 1971;9:97-113.Crossref 37. Wechsler D. Echelle d'intelligence de Welchsler pour adultes . 2nd ed. Paris, France: Editions du Centre de Psychologie Appliquée; 1970. 38. Folstein MF, Folstein SE, McHugh PR. 'Mini-mental state': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 39. Leclercq M, Chipp P, Blandel A, et al. A simple reaction times set. Presented at the European Symposium on Microcomputers in Neuropsychological Assessment and Rehabilitation; November 2-3, 1988; Strasbourg, France. 40. Lezak M. Neuropsychological Assessment . 3rd ed. Oxford, England: Oxford University Press; 1983. 41. De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the token test . Cortex . 1978;14:41-49.Crossref 42. Luria AR. Les fonctions corticales supérieures de l'Homme . Paris, France: Presse Universitaire de France; 1978. 43. Baddeley A. Working Memory . Oxford, England: Oxford University Press; 1986. 44. Stuss DT, Benson DF. The Frontal Lobes . New York, NY: Raven Press; 1986. 45. Nelson HE. A modified card sorting test sensitive to frontal lobe defects . Cortex . 1976;12:313-324.Crossref 46. Lhermitte F. 'Utilization behaviour' and its relation to lesions of the frontal lobes . Brain . 1983;106:237-255.Crossref 47. SAS Institute Inc. SAS User's Guide, Statistics: Version 6 Edition . Cary, NC: SAS Institute Inc; 1990. 48. Brown RA, Swanson Beck J. Medical Statistics on Microcomputers . Plymouth, England: Latimer Trend and Co Ltd; 1990. 49. Morrison DF. Multivariate Statistical Methods . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1976. 50. American Psychiatric Association, Committee on Nomenclature and Statistics . Diagnosis and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 51. Shallice T. Specific impairments of planning . Phil Trans Soc Lond . 1982;B298:1 99-209.Crossref 52. Milner B. Effects of different brain lesions on card sorting: the role of the frontal lobe . Arch Neurol . 1963;9:90-100.Crossref 53. Reitan RM. Validity of the Trail Making Test as an indication of organic brain damage . Percept Mot Skills . 1958;8:271-276.Crossref 54. Loeb C, Gandolfo C, Bino G. Intellectual impairment and cerebral lesions in multiple cerebral infarcts . Stroke . 1988;19:560-565.Crossref 55. Kemp JM, Powell TP. The cortico-striate projection in the monkey . Brain . 1970;93:525-546.Crossref 56. Yeterian E, Van Hoesen GW. Cortico-striate projections in the rhesus monkey: the organization of certain cortico-caudate connections . Brain Res . 1978;139:43-63.Crossref 57. Alexander G, De Long M, Strick P. Parallel organization of functionally segregated circuits linking basal ganglia and cortex . Ann Rev Neurosci . 1986;9:357-381.Crossref 58. Rosvold HE, Delgado JMR. The effect on delayed alternation test performance of stimulating or destroying structures within the frontal lobes of the monkey's brain . J Comp Physiol Psychol . 1956;49:365-372.Crossref 59. Johnson TN, Rosvold HE, Mishkin M. Projections from behaviourally-defined sectors of the prefrontal cortex to the basal ganglia, septum, and diencephalon of the monkey . Exp Neurol . 1968;21:20-34.Crossref 60. Rolls ET, Thorpe SJ, Madeson SP. Responses of striatal neurons in behaving monkey, I: head of caudate nucleus . Behav Brain Res . 1983;7:179-210.Crossref 61. Mishkin M, Malamut B, Bachevalier J. Memory and habits: 2 neural systems . In: Lynch G, McGaugh JL, Weinberger NM, eds. Neurobiology of Learning and Memory . London, England: Guilford Press; 1984. 62. Butters M, Wolfe J, Martone M, Granholm E, Czermak LS. Memory disorders associated with Huntington's disease . Neuropsychologia . 1985;23:729-743.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Frontal Lobe Dysfunction in Unilateral Lenticulostriate Infarcts: Prominent Role of Cortical Lesions

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American Medical Association
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Copyright © 1992 American Medical Association. All Rights Reserved.
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0003-9942
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1538-3687
DOI
10.1001/archneur.1992.00530360087023
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Abstract

Abstract • Most studies on frontal lobe dysfunction (FLD) in patients with striatal lesions did not consider possible associated cortical lesions not seen on computed tomographic scans. To determine the possible role of such cortical lesions, we assessed FLD in 10 patients with unilateral lenticulostriate infarct on computed tomographic scans. Magnetic resonance imaging revealed an associated cortical infarct not seen on computed tomographic scans in four patients. Using a battery of neuropsychological tests sensitive to FLD, we found that (1) the crossed tapping test was the only FLD test significantly disturbed in patients with pure unilateral lenticulostriate infarcts, (2) FLD was only present in patients with associated cortical infarct, and (3) caudate lesions only account for the number of echopraxic errors in the crossed tapping test. We conclude that unilateral isolated lenticulostriate infarcts might not lead to FLD, even though they may disturb the development of strategies involved in motor procedural learning. References 1. McHugh PR, Folstein MF. Psychiatric syndromes of Huntington's chorea: a clinical and phenomenologic study . In: Benson DF, Blumer D, eds. Psychiatric Aspects of Neurologic Diseases . New York, NY: Grune & Stratton; 1975:281-290. 2. Butters N, Sax D, Montgomery K, Tarlow S. Comparison of the neuropsychological deficits associated with early and advanced Huntington's disease . Arch Neurol . 1978;35:585-589.Crossref 3. Caine E, Hunter H, Weingartner H, Ebert M. Huntington's dementia . Arch Gen Psychiatry . 1978;35:377-384.Crossref 4. Jason GW, Pajurkova EM, Suchowersky O, et al. Presymptomatic neuropsychological impairment in Huntington's disease . Arch Neurol . 1988;45:769-773.Crossref 5. Hayden MR, Martin W, Stoessl AJ, et al. Positron emission tomography in the early diagnosis of Huntington's disease . Neurology . 1986;36:888-895.Crossref 6. Kuhl D, Phelps M, Markam C, Metter J, Riege W, Winter J. Cerebral metabolism and atrophy in Huntington's disease determined by 18 FDG and CT scans . Ann Neurol . 1982;12:425-434.Crossref 7. Mazziotta JC, Wapenski J, Phelps M, et al. Striatal glucose utilization in Huntington's disease . Neurology . 1985;35( (suppl) ):109. 8. Phelps ME, Mazziotta JC. Positron emission tomography: human brain function and biochemistry . Science . 1985;288:799-809.Crossref 9. Weinberger D, Berman K, ladarola M, Driesen N, Zec F. Prefrontal cortical blood flow and cognitive function in Huntington's disease . J Neurol Neurosurg Psychiatry . 1988;51:94-104.Crossref 10. Bowen FP, Kameny M, Burns M, Yahr MD. Effects of levodopa treatment on concept formation . Neurology . 1976;25:701-704.Crossref 11. Saint Cyr A, Taylor A, Lang A. Procedural learning and neostriatal dysfunction in man . Brain . 1988;111:941-959.Crossref 12. Lichter D, Corbett A, Fitzgibbon G, et al. Cognitive and motor dysfunction in Parkinson's disease . Arch Neurol . 1988;45:854-860.Crossref 13. Taylor A, Saint Cyr J, Lang A. Frontal lobe dysfunction in Parkinson's disease . Brain . 1986;109:845-883.Crossref 14. Teuber HL, Battersby WS, Bender MB. Performance of complex visual tasks after cerebral lesions . J Nerv Ment Dis . 1951;114:413-419. 15. Fuster JM. The Prefrontal Cortex . 2nd ed. New York, NY: Raven Press; 1989. 16. Cambier J, Masson M, Viader F, Limodin J, Strube A. Le syndrome frontal de la paralysie supranucléaire progressive . Rev Neurol . 1985;141:528-536. 17. Maher ER, Smith EM, Lees AJ. Cognitive deficits in the Steele Richardson Oleszewski syndrome . J Neurol Neurosurg Psychiatry . 1985;48:1234-1239.Crossref 18. Pillon B, Dubois B, Lhermitte F, Agid Y. Heterogeneity of cognitive impairment in progressive supranuclear palsy, Parkinson's disease and Alzheimer's disease . Neurology . 1986;36:1179-1185.Crossref 19. D'Antona R, Baron JC, Samson Y, et al. Subcortical dementia: frontal cortex hypometabolism detected by positron emission tomography in patients with progressive supranuclear palsy . Brain . 1985;108:785-799.Crossref 20. Goffinet AM, De Voider AG, Gillain C, et al. Positron tomography demonstrates frontal lobe hypometabol ism in progressive supranuclear palsy . Ann Neurol . 1989;25:131-139.Crossref 21. Blin J, Baron JC, Dubois B, et al. PET study in progressive supranuclear palsy . Arch Neurol . 1990;47:747-752.Crossref 22. Leenders KL, Frackowiack RSJ, Leers AJ. Steele Richardson Olszeski syndrome: brain energy metabolism, blood flow and fluorodopa uptake measures by positron emission tomography . Brain . 1988;111:615-630.Crossref 23. Mendez M, Adams N, Lewandowski K. Neurobehavioural changes associated with caudate lesions . Neurology . 1989;39:349-354.Crossref 24. Cambier J, Elghozi D, Strube E. Hémorragie de la tête du noyau caudé gauche . Rev Neurol . 1979;135:763-774. 25. Caplan LR, Schmahmann J, Kase C, et al. Caudate infarcts . Arch Neurol . 1990;47:133-143.Crossref 26. Pedrazzi P, Bogousslavsky J, Regli F. Hématomes limités à la tête du noyau caudé . Rev Neurol . 1990;146:726-738. 27. Anderson S, Damasio H, Tranel D. Neuropsychological impairments associated with lesions caused by tumor or stroke . Arch Neurol . 1990;47:397-405.Crossref 28. Delpla P, Meyer E, Zatorre R, et al. Metabolic and neuropsychological correlates of periventricular lucencies . J Cereb Blood Flow Metab . 1990;9( (suppl 1) ):S569. 29. Levine R, Lagreze H, Dobkin J, Turski P. Large subcortical hemispheric infarctions . Arch Neurol . 1988;45:1074-1077.Crossref 30. Weiller C, Ringelstein B, Reiche W, Thron A, Buell U. The large striatocapsular infarct: a clinical and pathological entity . Arch Neurol . 1990;47:1085-1091.Crossref 31. Donnan G, Bladin P, Berkovic S, Longley W, Saling M. The stroke syndrome of striatocapsular infarction . Brain . 1991;114:51-70. 32. Damasio HA. CT guide to the identification of cerebral vascular territory . Arch Neurol . 1983;140:138-142.Crossref 33. Takahashi S, Goto K, Fukasawa H, Kawata Y, Uemura K, Suzuki K. CT of cerebral infarction along the distribution of the basal perforating arteries . Radiology . 1985;155:107-118.Crossref 34. Daniels D, Haughton V, Naidich T. Cranial and Spinal Magnetic Resonance Imaging . New York, NY: Raven Press; 1987. 35. Fazekas F, Chawluk JB, Alavi A, Hurtig Ml, Zimmerman RA. MR signal abnormality at 1.5 T in Alzheimer dementia and normal aging . AJNR Am J Neuroradiol . 1987;8:421-426. 36. Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory . Neuropsychologia . 1971;9:97-113.Crossref 37. Wechsler D. Echelle d'intelligence de Welchsler pour adultes . 2nd ed. Paris, France: Editions du Centre de Psychologie Appliquée; 1970. 38. Folstein MF, Folstein SE, McHugh PR. 'Mini-mental state': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 39. Leclercq M, Chipp P, Blandel A, et al. A simple reaction times set. Presented at the European Symposium on Microcomputers in Neuropsychological Assessment and Rehabilitation; November 2-3, 1988; Strasbourg, France. 40. Lezak M. Neuropsychological Assessment . 3rd ed. Oxford, England: Oxford University Press; 1983. 41. De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the token test . Cortex . 1978;14:41-49.Crossref 42. Luria AR. Les fonctions corticales supérieures de l'Homme . Paris, France: Presse Universitaire de France; 1978. 43. Baddeley A. Working Memory . Oxford, England: Oxford University Press; 1986. 44. Stuss DT, Benson DF. The Frontal Lobes . New York, NY: Raven Press; 1986. 45. Nelson HE. A modified card sorting test sensitive to frontal lobe defects . Cortex . 1976;12:313-324.Crossref 46. Lhermitte F. 'Utilization behaviour' and its relation to lesions of the frontal lobes . Brain . 1983;106:237-255.Crossref 47. SAS Institute Inc. SAS User's Guide, Statistics: Version 6 Edition . Cary, NC: SAS Institute Inc; 1990. 48. Brown RA, Swanson Beck J. Medical Statistics on Microcomputers . Plymouth, England: Latimer Trend and Co Ltd; 1990. 49. Morrison DF. Multivariate Statistical Methods . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1976. 50. American Psychiatric Association, Committee on Nomenclature and Statistics . Diagnosis and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 51. Shallice T. Specific impairments of planning . Phil Trans Soc Lond . 1982;B298:1 99-209.Crossref 52. Milner B. Effects of different brain lesions on card sorting: the role of the frontal lobe . Arch Neurol . 1963;9:90-100.Crossref 53. Reitan RM. Validity of the Trail Making Test as an indication of organic brain damage . Percept Mot Skills . 1958;8:271-276.Crossref 54. Loeb C, Gandolfo C, Bino G. Intellectual impairment and cerebral lesions in multiple cerebral infarcts . Stroke . 1988;19:560-565.Crossref 55. Kemp JM, Powell TP. The cortico-striate projection in the monkey . Brain . 1970;93:525-546.Crossref 56. Yeterian E, Van Hoesen GW. Cortico-striate projections in the rhesus monkey: the organization of certain cortico-caudate connections . Brain Res . 1978;139:43-63.Crossref 57. Alexander G, De Long M, Strick P. Parallel organization of functionally segregated circuits linking basal ganglia and cortex . Ann Rev Neurosci . 1986;9:357-381.Crossref 58. Rosvold HE, Delgado JMR. The effect on delayed alternation test performance of stimulating or destroying structures within the frontal lobes of the monkey's brain . J Comp Physiol Psychol . 1956;49:365-372.Crossref 59. Johnson TN, Rosvold HE, Mishkin M. Projections from behaviourally-defined sectors of the prefrontal cortex to the basal ganglia, septum, and diencephalon of the monkey . Exp Neurol . 1968;21:20-34.Crossref 60. Rolls ET, Thorpe SJ, Madeson SP. Responses of striatal neurons in behaving monkey, I: head of caudate nucleus . Behav Brain Res . 1983;7:179-210.Crossref 61. Mishkin M, Malamut B, Bachevalier J. Memory and habits: 2 neural systems . In: Lynch G, McGaugh JL, Weinberger NM, eds. Neurobiology of Learning and Memory . London, England: Guilford Press; 1984. 62. Butters M, Wolfe J, Martone M, Granholm E, Czermak LS. Memory disorders associated with Huntington's disease . Neuropsychologia . 1985;23:729-743.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Dec 1, 1992

References