갑자기 발생한 기억력 장애와 이름대기 장애를 주소로 내원한 환자 3례

Presentation on theme: "갑자기 발생한 기억력 장애와 이름대기 장애를 주소로 내원한 환자 3례"— Presentation transcript:

1 갑자기 발생한 기억력 장애와 이름대기 장애를 주소로 내원한 환자 3례
가톨릭 대학교 성모병원 신경과 양 동 원

2 Case 1 57/M, left right handed 생각한대로 표현이 안 된다 기억력이 떨어진다
말을 잘 알아 듣지 못한다 말을 조리 있게 하지 못한다 같은 행동을 반복한다 시간의 순서를 잘못 기억한다

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4 Case 2 68/F, right handed 졸려 하신다, 행동이 느려졌다 말이 많으신 분인데 말수가 줄었다
이야기를 빨리 하지 못한다 자기가 말을 하고서 되물어 본다 메모를 해 드려도 잊어 버린다 물건을 보면 알겠는데 다른 말이 나오거나 말이 생각이 나지 않는다

5 Case 3 72/M, right handed 잠을 자꾸 자고 엉뚱한 소리를 한다 잘 다니던 곳인데 여기가 어디냐 묻는다
(2년 넘게 다니던 세브란스 병원) 뭘 들어도 자꾸 잊어버린다 말을 조리 있게 하지 못한다 행동이 느리다

6 Demographic data Case 1 Case 2 Case 3 Age 57 68 72 Sex M F Education
16 20 11 Handedness Left Right Behavior abnormality Drowsy - + Apathy Depression Neurologic examination No abnormal

7 Result of Neuropsychological test
Cognitive domain/ Neuropsychologic test Case 1 Case 2 Case 3 Attention Digit span: Forward/backward 7/2 4/3 6/4 Letter cancellation Normal Memory Orientation: T/P(5/5) 4/4 5/5 4/5 Remote memory:president(5) 5 3 word registration/recall 3/0 SVLT: Free R(1+2+3=T/delayed) 2+2+2=6/0 3+6+5=14/2 2+3+3=8/0 Recognition (TP-FP=) 기억 없음 3-0=3 1-0=1 Rey Figure Immediate R/delayed R 13/12 9/8 5-0=5 9-3=6 9-1=8

8 Cognitive domain/ Neuropsychologic test Case 1 Case 2 Case 3
Visuospatial functions Interlocking pentagon Normal Rey figure copy 30/36 34/36 36/36 Frontal/Executive functions Contrasting program Go-no-go test Abnormal Fist-edge-palm Alternating hand movement Alternating square and triangle Closing in Luria loop Semantic word fluency Animal/supermarket items 3/2=5 8/6=14 6/7=13 Phonemic word fluency:ㄱ/ㅅ/ㅇ 5/2/3=10 1/1/0=2 5/4/2=11 Stroop test: Word reading: correct/incorrect 112/0 110/2 112/112 Color naming: correct/incorrect 20/20 64/12 67/5

9 Cognitive domain/ Neuropsychologic test Case 1 Case 2 Case 3
Language & related functions Fluency Slight reduced Auditory comprehension Normal Repetition Naming (K-BNT) 21/60(<5%ile) 26/60(<0%ile) 25/60 (<0%ile) Reading Writing Word finding difficulty Frequent Sometimes Paraphasia Absent Calculation Abnormal Praxis Present K-MMSE 23 22 24 CDR 1(SOB=6) 0.5(SOB=1.5) 1(SOB=1)

10 Lesion site?

11 MRI Findings Case 1 Case 2 Case 3

12 EDC SPECT of Case 1

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16 Western Aphasia Battery

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19 Western aphasia battery Case 1 Case 2 Case 3
1. 스스로 말하기 내용전달/유창성/합계(AQ):20 8/8=16 8/9=17 7/9=16 2. 알아듣기 예- 아니오 검사 60/60 청각적 낱말인지 명령이행 76/80 80/80 78/80 AQ=합계/20=10 196/20=9.8 200/20=10 198/20=9.9 3. 따라 말하기 AQ=합계/10=10 100/10=10 88/10=8.8 4. 이름 대기 물건 이름대기 56/60 52/60 동물 이름대기 3/20 8/20 6/20 문장완성 8/10 10/10 문장응답 77/10=7.7 78/10=7.8 Aphasia Quotient( )*2 87 89.2 87.4

20 Aphasia type? Western aphasia battery Case 1 Case 2 Case 3 5.읽기
90/10=9 80/10=8 6.쓰기 97/10=9.7 91/10=9.1 100/10=10 Aphasia type ? Aphasia type?

21 Anatomy of anterior thalamic nucleus
Blood supply Tuberothalamic (Polar) artery form P-com Afferent *Mammillary body (mammillothalamic tract) *Ventral amygdalofugal fiber (inferior thalamic peduncle) Efferent cingulate gyrus

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24 Input Nucleus Output Amygdala/perirhinal cortex Inferior temporal cortex Hypothalamus Intralaminar thalamic nucleus dorsomedial thalamus pre-frontal lobes mamillary bodies... anterior nuclei cingulate gyrus & hippocampus Supplementary motor Anterior insular cortex

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26 Ventral amygdalofugal fiber through anterior perforated substance to basal nuc Meynert, HT, MD thalamus

27 Neuropsychological disturbances of Ant. Thalamic lesion
Disturbances of alertness Intralaminar, reticular, ventral anterior nuclei Apathy , disinterest, lack of drive for motor expression anterior thalamic nucleus- cingulate gyrus: frontal hypometabolism Memory disturbance * Mammillothalamic tract * Ventral amygdalofugal fiber (perirhinal cortex) Left : verbal, Right: visuospatial Anterograde, sometimes retrograde, disorientation to time, normal working memory

28 Aphasia of thalamic lesions
Anterior thalamic lesion Aspontaneity, diminished content of speech, paraphasia, decreased generation of words, defects of spelling, comprehension, reading and writing, preserved repetition Paramedian thalamic lesion Poor initiation of speech, poverty of output, occasional confabulation, lack of output monitoring, intact repetition, deficit in word-list generation and naming, perceptive errors, nonaphasic misnaming, intrusion, perseveration Non phonemic or semantic paraphsia “ Subtranscortical aphasia” Lack of initiation of speech, disruption of speech by memory and arousal disturbances Damage to the frontal lobe- inferior thalamic peduncle-nucleus reticularis-centre median system In our cases = anomic aphasia :Frontal dysfunction?, lexicon damage

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