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2008 ; 20
(3
): 83-9
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Isolated right temporal lobe stroke patients present with Geschwind Gastaut
syndrome, frontal network syndrome and delusional misidentification syndromes
#MMPMID19641245
Hoffmann M
Behav Neurol
2008[]; 20
(3
): 83-9
PMID19641245
show ga
BACKGROUND: Right temporal lobe lesion syndrome elicitation presents a clinical
challenge. Aside from occasional covert quadrantanopias, heralding elementary
neurological deficits are absent. AIM: Isolated right and left temporal lobe
stroke patients were analyzed for the panoply of known temporal and frontal
cognitive and neuropsychiatric syndromes. METHODS: Temporal lobe stroke patients
were analyzed, derived from a dedicated cognitive stroke registry. Patients were
screened by a validated bedside cognitive battery and a neuropsychological test
battery, including the Bear Fedio Inventory for diagnosis of the Geschwind
Gastaut (GG) syndrome, frontal network syndrome testing (FNS), emotional
intelligence testing and delusional misidentification syndromes (DMIS). NIH
stroke scores were documented and lesion location identified with the 3
dimensional digitized Cerefy coxial brain atlas. Exclusions were coma,
encephalopathy and medication related effects. RESULTS: Of 2389 patients
analyzed, in patients with isolated right temporal lobe (IRT) stroke (n = 5,
infarcts n = 3, hemorrhage n = 2), the GG syndrome and FNS were present in all
five. Other relatively frequent syndromes included DMIS in 4, visuospatial
dysfunction in 2 and amusia in 2. No patient had a NIHSS greater than 1. The only
elementary neurological sign was quadrantanopia in 3 patients. Lesion location
was mid and lateral temporal lobe (n = 2), middle and mesial temporal lobe (n =
1) middle temporal lobe (n = 1) and lateral temporal lobe (n = 1). Comparison
with isolated left temporal lobe (ILT) stroke revealed syndromes of aphasia (n =
4), alexia (n = 2), acalculia (n = 2), agnosia (n = 2), verbal amnesia (n = 1),
none of which occurred in the IRT patients. The mean NIHSS scores of IRT (0.6)
and ILT strokes (4.2) was different (t = 2.23, p = 0.04). The 2 x 8 Fisher Exact
Test revealed significant differences for the clusters of syndromes occurring in
the right and left isolated temporal lobe lesions (p = 0.00002). CONCLUSION: The
GG syndrome, FNS and DMIS are prominent syndrome constellations in stroke
patients involving the right temporal lobe and constitute the neurological
deficit without heralding long tract signs. By extrapolation these syndromes may
also be present in the general right hemisphere lesion population.