Caudate strokes

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):

  • Agitation
  • Abulia
  • Neglect (right sided lesions, 25%)
  • Mood changes (1/3)
  • Memory disturbance (1/3, bilateral: dementia)
  • Dysarthria
  • 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.




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