A 49-year-old woman, separated, mother of family.
Established in 2003 an embolic cerebral infarction (during coronary catheter ablation due to Wolf-Parkinson-White syndrome), with possible subsequent bleeding.
Two months after the infarction, MRI showed involvement of the lenticular nucleus and the middle portion of the left cauda nucleus, and to a lesser extent of the knee of the internal capsule.
Positron emission tomography (PET) also describes:
- Absence of metabolism in the lenticular nucleus, the tail of the corpus callosum and the thalamic anteromedial region of the left hemisphere.
- Asymmetry in dorsolateral corticofrontal metabolism.
- Contralateral cerebellar dyskinesia.
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Clinically he presented motor aphasia and right hemiplegia, with subsequent recovery (except slight residual dysarthria).
During the evolution there was a very significant behavioral change, with changes in his personality and previous values.
In order to evaluate the changes, we took into account information provided by family members, clinical and legal records, and not only self-reported information by the patient.
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Currently, hospitalization is required for presenting behavioral alterations and risk of self-harm, as well as for performing a diagnostic evaluation.
During this process, its usual pattern of functioning is evident.
Acute pathology was ruled out in several studies:
- CT: left carotid-striate residual ischaemic lesion.
- MR: chronic infarction and left lenticular nucleus with secondary Wallerian degeneration of the corticospinal pathway.
- EEG: without specific abnormalities.
- Complete blood tests: normal.
In the neuropsychological evaluation of superior executive capacities, especially of planning and problem solving processes6, he presents a dysexecutive syndrome of dorsolateral prefrontal and orbitofrontal-ventromedial localization.
It shows dispersion of care, difficulty of understanding, blocks, high cognitive interference, lack of planning, affectation of working memory and slow processing speed.
It maintains a rigid, perseverant pattern, without benefiting from learning and repetition.
It shows difficulties in anticipating the consequences of its acts and affectation of the marker so that it is unable to assess the risk of its decisions.
