We use cookies to distinguish you from other users and to provide you with a better experience on our websites. The literature also mentions a few cases of yawning associated with stroke in the insula or the caudate nucleus. The main risk factors for caudate infarct were hypertension (64%), hypercholesterolemia (32%), diabetes mellitus (28%), and previous myocardial infarct (20%). In all cases, MCN and LCN were affected, and in 5 patients only the VCN was involved. Left caudate infarcts were present in 11 patients (44%). Typically, tissue plasminogen activator may be administered within 3 to 4.5 hours of stroke onset if the patient is without contraindications (i.e. The neuropsychological findings were evaluated by measuring cognitive, language, spatial, and mnemonic functions in our neuropsychology laboratory within the first week of the stroke. Single-photon emission CT imaging revealed hypoperfusion in the left frontal and temporoparietal lobes. In one register study 23 , it was reported that patients with caudate stroke constituted only 1% of a total number of 3050 stroke patients (2450 ischaemic stroke and 600 haemorrhagic stroke). Infarcts extended into the anterior limb of the internal capsule in 9 patients, and also the anterior putamen in 5 patients. The first individual automated volumetric analysis of basal ganglia and thalamus at the Fig. One (patient 21) had severe impairment of motor and mental activity with flat affect and could not move unless asked to eat or to stand up. Eighteen patients had caudate nucleus infarcts (10 left-sided; 8 right-sided). Specifically, scientists believed it controlled movement that the person was aware of and performed consciously, rather than unconscious or reactive movement. The caudate nucleus is one of the structures that make up the corpus striatum, which is a component of the basal ganglia. Three of the patients (50%) (patients 27, 28, and 31) presented with an altered level of consciousness (confusion-disorientation). in mean raw right caudate nucleus volume between subjects with Within controls there was a trend (P = 0.052) towards hemispheric Stroke compared to VaD: F(3,34) = 5.620, P = 0.003, with a moderate asymmetry of caudate nucleus volume with the right caudate nucleus effect size (eta-squared = 0.352). Among them, 4 patients had isolated caudate lesions, others had involvement of the anterior limb, and only 1 had spread to the putamen. Motor-exploratory neglect was assessed by blindfolded manual exploration described by Weintraub and Mesulam,16 which measures the exploration of ipsilesional and contralesional space by the nonparetic right hand. Templates through the caudate nucleus depicting infarcts in 3 arterial territories. Synonyms for caudate nucleus in Free Thesaurus. Steinbrecher, Andreas National Center These terms describe a continuum from minor to major absence of observable behavior, and despite the advanced behavioral stage, some intellectual and cognitive functions could be retained. It is documented that the caudate nucleus is involved in degenerative diseases of the central nervous system such as Parkinson disease and Huntington disease. The tail of the caudate nucleus terminates immediately above the temporal horn of the ventricle. We studied a series of patients with caudate infarcts or hemorrhages involving the head of the caudate nucleus (confirmed by CT and MRI), stroke etiology, clinical profiles, and behavioral abnormalities. Damage to the caudate nucleus, putamen, and thalamus is also related to spasticity in the lower limbs of stroke patients. Two patients (8%) with left caudate infarct had generalized convulsion at stroke onset. Patients with involvement of the anterior limb of the internal capsule (patients 12, 13, 19, and 20) had predominantly faciobrachial paresis, and 1 patient (patient 13) had decreased spontaneity and speech. There is a caudate nucleus within each hemisphere of the brain. The American Heart Association is qualified 501(c)(3) tax-exempt The behavioral abnormalities were mostly due to medial, lateral, and ventral caudate subnuclei damage and coexisting lesion of the anterior limb of the internal capsule. Statistical data on risk factors and stroke mechanism were analyzed with χ2 and Fisher’s exact tests. Visual amnesia was considered present when there was a deficit in recognizing figures presented visually as evaluated by F form of the Benton Visual Retention Test (total maximum score of 15 points; a score of ≤9 indicates visual amnesia). Patients with large caudate involvement, which showed deep extension (patients 3, 5, 8, and 9), had prominent motor and various neuropsychological abnormalities. Is the cerebellum a motor control device. Customer Service Hemineglect was occasionally reported in patients with right caudate lesions and has not been systematically studied in either infarct or hemorrhage. Parkinsonism after stroke is associated with lesions in the basal ganglia (mainly striatum or lentiform nucleus) which can be unilateral or … Damage to the caudate nucleus, putamen, and thalamus is also related to spasticity in the lower limbs of stroke patients. Aphasia resolved in 2 weeks in all patients except 1 with global aphasia. We considered the following as potential causes of caudate ischemic stroke: (1) large-artery disease was presumed in patients who had a stenosis of ≥50% of the lumen diameter in the appropriate large artery as shown on duplex, transcranial Doppler, or MR angiography; (2) small-artery disease in patients with longstanding hypertension or diabetes mellitus and a small (<15 mm) infarct limited to the territory of deep perforators on CT scan or MRI in the absence of other etiologies; (3) potential cardiac sources of embolism including NVAF, left ventricular dyskinetic segment, intracardiac thrombus or tumor, mitral stenosis, and other less common sources; (4) mixed etiology in cases of coexistence of large-artery disease and potential cardiac sources of embolism; (5) other and undetermined etiologies. I particularly like Mendez’ classification of caudate behavioural abnormalities: This site uses cookies. Pure motor stroke caused by an infarct in the internal capsule is the most common lacunar syndrome. Grönholm EO (1), Roll MC (2), Horne MA (2), Sundgren PC (3), Lindgren AG (1) (4). There was a history of transient ischemic attack in 13 patients (56%) with anterior circulation symptoms. We considered the following as functional outcome measures for patients: (1) independent patients with minor neurological deficit such as dysarthria and minimal hand or leg weakness that does not prevent performance of normal activities; (2) mildly dependent patients with motor deficit that limits previous activities and who need some help for walking; (3) dependent patients with major neurological deficits such as being bedridden and incontinent and who require constant nursing and attention and could not return to any previous activities; and (4) death. The recurrent artery of Heubner was involved in only 1 patient with syphilitic vasculitis that affected the inferior part of the caudate nucleus, the anterior part of the capsule, and the nucleus accumbens. Shown are coronal view (left) and horizontal view (right) of the caudate arterial territories. - Acute Lesions of the Caudate Nucleus The clinical features of both ischemic and hemorrhagic strokes involving the caudate nucleus include behavioral abnormalities, dysarthria, movement disorders, language disturbances, and memory loss. Functions of the lentiform nucleus. The caudate nucleus is thought to play a role in stereotyped and repetitive function and is a part of the corticostriatothalamocortical loop, which is involved in hyperkinetic and hypokinetic movement disorders (Parkinson and Huntington diseases) and mental disorders (attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and Tourette syndrome).1, 2, 3, 4, 5 … Figure 2. 2012), and complex focal seizures (Penfield and Jasper 1954). We studied a series of patients with caudate infarcts or hemorrhages involving the head of the caudate nucleus (confirmed by CT and MRI), stroke etiology, clinical profiles, and behavioral abnormalities. Demographic Data, Risk Factors, and Cause of Infarct in Patients With Caudate Infarct. 1. 2012 ), and complex focal seizures (Penfield and Jasper 1954 ). other findings suggest acute haemotoma in left caudate nucleus, chron Dr. John Rhoades answered The caudate nucleus is a collection of neurons located within the basal ganglia, near the thalamus. One half of the patients had abulia, characterized by decreased spontaneous activity and speech and prolonged latency in responding to questions and other stimuli. other findings suggest acute haemotoma in left caudate nucleus… Eight patients (33%) had large infarct of the caudate nucleus involving neighboring structure (Figure 2). The control group was largest in overall mean volume of the diagnostic groups, followed by the Stroke group (86% of controls), and finally, the VaD group (72%). Antonyms for caudate nucleus. Dysphagia and aspiration in the lateral medullary syndrome usually occur with involvement of the rostral and dorsolateral parts of the medulla oblongata. A database containing risk factors, clinical features, type and mechanism of stroke, and caudate vascular territories was analyzed. We evaluated all patients with a diagnosis of caudate stroke admitted to Ege University Hospital Stroke Unit, Izmir, Turkey, over a 5-year period. Our findings suggest that small-artery disease and a cardiac source of embolism are the main causes of caudate ischemic stroke; large-artery disease was present in only one sixth of the patients. The region is innervated with dopamine neurons. Nonfluent aphasia with repetition abnormality (patients 3 and 9), transcortical motor aphasia (patient 8), and global aphasia (patient 5) occurred in patients with large caudate and deep infarct. Keywords: Caudate nucleus, stroke, cognitive impairment, behavioral disorder, computed tomography, magnetic resonance imaging Introduction It is generally believed that mental and behav-ioral disorders can be caused by acquired fron - tal and temporal lesions. Early on, scientists thought the caudate nucleus was used to control movement of the limbs. Three patients with bilateral involvement of the caudate head had acute confusion and disorientation at stroke onset. Thirteen patients had dysarthria; 10 patients had unilateral caudate infarct (5/11, right side; 5/11, left side), 2 patients had bilateral caudate infarct (2/3), and 1 patient had left caudate hemorrhage (1/6). Parallel organization of functionally segregated circuits linking basal ganglia and cortex, Clinical neurology of striatocapsular infarction, Neurological syndrome following bilateral damage to the head of the caudate nucleus, A novel disorder of linguistic expression following left caudate nucleus infarction, Neurobehavioral changes associated with caudate lesions, Unilateral hypokinesia and motor extension, Remote effects of caudate hemorrhage: a clinical and functional study, Aphasia with nonhemorrhagic lesions in the basal ganglia and internal capsule, Counterpointing the functional role of the forebrain and of the brain stem in the control of the sleep-waking system, The primate basal ganglia: parallel and integrative networks, Update on models of basal ganglia function and dysfunction, The lateral perforating branches of the anterior and middle cerebral arteries, The arterial and venous blood supplies to the forebrain (including the internal capsule) of primates, Surgical anatomy of the proximal anterior cerebral artery, Microvascular anatomy of Heubner's recurrent artery, Deep perforators from the carotid system: template of the vascular territories, Arterial vascularisation and angioarchitecture of the nucleus caudatus in human brain, Lacunar and Other Subcortical Infarctions, Correlation of subcortical CT lesion sites and aphasia profiles, Verbal memory deterioration after unilateral infarct of the internal capsule in an adolescent, Perte de l'autoactivation psychique: activité compulsive d'allure obsessionnelle: lésion lenticulaire bilatérale, Pure psychic akinesia with bilateral lesions of basal ganglia, Long-term cognitive impairment associated with caudate stroke, Bilateral infarction of the caudate nuclei, Aphasia and neglect after subcortical stroke: a clinical-cerebral perfusion correlation study, Hemichorea and hemiballismus: recent concepts, Parallelism caused by bilateral hemorrhagic infarction in the basal ganglia, Generalized chorea due to bilateral small deep cerebral infarcts, Symptomatic hemidystonia of delayed onset. Individually, they resemble a C-shape structure with a wider head at the front, tapering to a body and a tail. Caudate infarcts. Another differential diagnosis that may be considered is the striatocapsular infarct, a comma-shaped infarct of the caudate nucleus, the putamen, and the anterior limb of the internal capsule. Hypertension was present in 4 patients (67%) with caudate hemorrhage, and arteriovenous malformation was present in 1 patient (17%). Caudate strokes September 26, 2011 jneuro Neurology Stroke We run through the case of a patient with bilateral caudate head lesions (one old, one new) and mention the famous neuropsychological and behavioural abnormalities, arising from caudate strokes. Three patients had psychic akinesia, characterized by severe mental and affective stagnation and lack of initiative for action and speech. Swallowing outcomes in patients with subcortical stroke associated with lesions of the caudate nucleus and insula. Results—Thirty-one patients had acute caudate stroke (24 men and 7 women; mean age, 62.3 years). A large caudate infarct was one >1.5 cm on >2 slices on CT and MRI. The facial motor nucleus and its associated nerve control the labial and facial muscles and participate in the oral and pharyngeal phases of swallowing. clinical and behavioral aspects of the patients with caudate lesions due to infarct or hemorrhage. The instruments included the Mini-Mental State Examination (Turkish version) (MMSE), with a total maximum score of 50 points; a score of ≤28 indicates significant cognitive impairment. Three patients with psychic akinesia had right-sided damage of the internal capsule with MCN or LCN territory infarct (patients 21, 24, and 25), and 2 patients had additional involvement of the MCN, LCN, and caudate fundus region on the left side (patients 24 and 25). Five patients with left-sided caudate infarcts had speech abnormalities. Among dysarthric patients, infarct was limited to the caudate nucleus in 2 (patients 11 and 17), 8 patients had involvement of the anterior limb of the internal capsule, and 2 had anterior putamen involvement. In previous studies, there is no mention of arterial territories involved in patients with caudate infarcts.123456 Actually, there is considerable overlap between the 3 arteries supplying the head of the caudate nucleus: the lateral lenticulostriate, anterior lenticulostriate, and Heubner’s recurrent artery.15192021 Anterior lenticulostriate arteries primarily circumscribed the MCN, LCN, and VCN and partially involved the anterior limb of the capsule. Patients with caudate stroke were 1% of our registry, which included 3050 patients (total, 2450 ischemic stroke and 600 hemorrhagic stroke). We excluded patients with previous strokes or with associated infarcts in the internal capsule, the caudate nucleus, or the thalamus. Among them, 3 patients developed a nonfluent type of aphasia characterized by nonfluent speech with syntax errors, repetition impairment, stuttering, word-finding difficulty, and preserved comprehension (patients 3, 6, and 9). The literature also mentions a few cases of yawning associated with stroke in the insula or the caudate nucleus. Caplan et al6 described 10 abulic patients with left-sided preponderance of caudate lesions. Global-type aphasia in this patient may be explained by intrahemispheric diaschisis. Schmahmann, Carlos S. Kase, MD; Edward Feldmann, MD; George Baquis, MD; John P. Greenberg, MD; PhillipB. A basal ganglia stroke affects the part of the brain that controls movement, perception, and judgment. On follow-up 3 months later, 5 patients (2 with right-sided, 2 with left-sided, 1 with bilateral lesions) developed major depression according to the criteria of DSM-IV (patients 8, 9, 21, 24, and 26). 89101112 There are few studies, however, of patients with unilateral caudate lesions that have examined long-term outcome of memory and mood disorders. Of the 6 patients with caudate hemorrhage (Table 3), hypertension was present in 4 patients (67%) and arteriovenous malformation in 1 patient (17%), while no cause of hemorrhage was determined in 1 patient (17%). Major depression was defined with the use of the symptom criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).17 Among behavioral abnormalities, abulia was defined in patients with decreased spontaneous activity, prolonged latency in responding to questions, fatigue, and an aversion to any activity. Check if you have access via personal or institutional login. Medically reviewed by Drugs.com. In a previous study, verbal comprehension and verbal memory deficits of the patient with caudate hemorrhage have been explained by dysfunction of the corticocaudate connections.12 Mendez et al5 showed that bilateral caudate lesions might yield global dementia, while unilateral lesions might cause impairment of frontal functions and decreased free recall of episodic and semantic items. The head of the caudate nucleus is concerned with multi-modal information processing and inhibition. Verbal amnesia (patients 2 and 3), visual and verbal amnesia (patient 10), anomia (patients 6, 8, and 9), and ideomotor and buccolingual apraxia (patient 5) were other characteristics of left caudate infarcts (Table 2). Patients with infarct in the territory of the lateral lenticulostriate arteries extending to neighboring structures showed more frequent motor and neuropsychological deficits than those with infarct in the territory of the anterior lenticulostriate arteries. The caudate nucleus plays a vital role in how the brain learns, specifically the storing and processing of memories. Moreover, these features were previously reported in patients with bilateral globus pallidus or putaminal lesions.3031 The abulic patients described by Fisher32 had lesions in the frontal lobes and underlying structures or in the thalamus and upper brain stem. Two patients with bilateral caudate infarcts, 3 patients with unilateral large caudate infarct in the territory of the lateral lenticulostriate arteries (20%), and 2 patients with caudate hemorrhage (33%) were dependent 1 year after stroke. Earlier studies that included caudate lesions involving neighboring anatomic structures, such as the putamen, internal capsule, and white matter, did not elucidate the clinical functions of the caudate nucleus head.12345678910111213 Studies on vascular lesions (either infarct or hemorrhage) of the caudate nucleus are few. Lacunar Stroke. Caudate infarct was present in 25 patients and caudate hemorrhage in 6. As defined by different authors, the caudate nucleus connects associative cortex, including frontal, parietal, and temporal lobes, with deeper anatomic structures by cortico-pallido-nigra-thalamo-cortical loops.2728 These loops are multiple, discrete, but partially overlapping and are integrated through their passage in pallidum and substantia nigra to the circumscribed nuclei of the thalamus, and from there they are projected back to their original lobar areas. 1, 2 . Two patients (patients 24 and 25) had unilateral faciobrachiocrural paresis, predominantly in the upper limb on the side contralateral to a lesion that involved the anterior limb of the internal capsule, and psychic akinesia. All patients with hemineglect had involvement of MCN, LCN, VCN, and neighboring structures. Symptoms and signs of internal capsule stroke include weakness of the face, arm, and/or leg (pure motor stroke).
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