Faculty Bibliography

Three patients became demented after surgery for cerebellar hemorrhage or infarction with acute hydrocephalus. All were inattentive, perseverative, and disoriented. They had difficulty with memory, and trouble solving arithmetic problems or copying geometric figures. None showed aphasia, apraxia, or agnosia, although one had word-finding difficulty. One improved substantially in 6 months; one improved slightly in 1 year, and one did not change. None had persistent hydrocephalus. Acute hydrocephalus may have damaged the periventricular white matter to cause the dementia

We studied the nature and causes of delusions after infarction of the right cerebral hemisphere. Delusions involved orientation in time and place, events in the recent past, and the identities of familiar individuals. Some were transient and disorganized, and others were more fixed. No particular site in the right hemisphere was associated with particular delusions. The different delusions may be varied manifestations of a basic disorder of thought and memory. The major determinant of the delusions was cerebral atrophy. Age, location, and size of lesion had no major effect. The superimposition of a new right hemisphere lesion on a diffusely atrophied brain seems to cause delusions that can be expressed verbally because the left hemisphere is relatively preserved

Severe Wernicke's aphasia occurred suddenly in a right-handed man and persisted with little improvement until he died 54 days later. Postmortem examination showed an infarct in the posterior temporoparietal region of the right hemisphere. This case demonstrates two new features of crossed dextral aphasia. First, language skills may be fully lateralized to the right hemisphere in right-handed patients. Second, when crossed lateralization occurs, the usual localization of aphasic syndromes is common, suggesting that the intrahemispheric organization mediating language activities is the same in the right hemisphere of the crossed dextral and the left hemisphere of the typical right-handed individual

Assessments of mood disturbance and 'vegetative' (appetite or sleep) disturbance as well as a single-dose dexamethasone suppression test (DST) were carried out in 25 randomly selected stroke patients and in 13 nonstroke control patients hospitalized in a rehabilitation center. Prevalence rates of moderate-to-serve depression of mood and vegetative disturbance were significantly higher in stroke patients than controls (48% and 52% versus 0% and 8%, respectively), as was the prevalence of abnormal DST results (52% versus 8%). Abnormal DST results were associated with the occurrence of moderate to severe mood, appetite, and sleep disturbances among all patients. in 2 stroke patients, repeated DST results paralleled the clinical course. The DST may be useful as an adjunct to the diagnosis and in monitoring the progress of the common and potentially reversible mood and vegetative disturbances occurring after stroke

We observed acute onset of delayed psychosis in 8 patients 1 month to 11 years after right temporoparietooccipital (TPO) stroke or trauma. The psychotic disorder included hallucinations and, in some patients delusions and agitation. All patients had spatioconstructional difficulties. None had an earlier psychiatric disorder. Seven of eight patients had clinical seizures, often in close temporal relationship to the psychosis. The pathophysiology of the psychosis may be related to that of the epilepsy