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.
I particularly like Mendez’ classification of caudate behavioural abnormalities:
- apathetic with decreased spontaneous verbal and motor activities (mainly dorsolateral caudate involvement)
- disinhibited, inappropriate and implusive (small ventromedial lesions)
- affective symptoms with psychotic features (dorsolateral caudate involvement, usually bigger infarcts)
En passant we talk about the localization of stroke-induced agitation (caudate, temporal lobe, parietooccipital).
Here are some of the clinical specialties in caudate strokes (taken from Kumral):
- Neglect (right sided lesions, 25%)
- Mood changes (1/3)
- Memory disturbance (1/3, bilateral: dementia)
- Aphasia (left sided lesions, 50%)
- Movement disorders (ballistic, choreatiform)
- Motor weakness
We discuss the vascular anatomy of the caudate nucleus, mention Heubner’s recurrent artery/arteries.
- Kumral. Acute caudal vascular lesions. Stroke 1999
- Bogousslavsky. The stroke syndromes (aka the stroke encyclopedia)