In the previous case reports, hemichorea has also been reported in ischemic and hemorrhagic caudate strokes in which the lesions extended into the anterior limb and putamen.222324 Moreover, hemiballismus and compulsive movement disorder due to caudate and concomitant striatal lesions were described.2526. Frontal lobe functions were assessed by the Stroop test and Luria’s conflicting tasks. The basal ganglia is a collection of interconnected subcortical nuclei (neuronal cell bodies) lying deep below the cortex. In addition to CT and MRI, other examinations performed were complete blood cell count and urinalysis, transcranial Doppler, duplex sonography of the carotid and vertebral arteries, 12-lead ECG, and, in some cases, transthoracic or transesophageal echocardiography and catheter angiography. Hemichorea without motor weakness occurred in only 1 patient with caudate ischemic stroke extending to the anterior putamen. It is composed of the caudate nucleus, the putamen, the nucleus accumbens (or ventral striatum) and the globus pallidus. The caudate ischemic stroke had a nonprogressive onset of symptoms (stabilized <1 hour) in 20 patients (80%) and was progressive (over 2 to 24 hours) in 5 patients (20%). Via inhibition the caudate is able to exert modulatory effects on motor activity and facial-gestural posture and expression, and aids in the maintenance of selective motoric attention, e.g. In previous series, small-artery disease occurred in two thirds, while a cardiac source of embolism was present in one fifth of the patients with unilateral caudate infarct.56 In our series, acute bilateral caudate infarcts developed primarily because of a cardiac source of embolism. Whether the prognoses of motor and anxiety disorders are related to the affected stroke area has not been reported. Functions of the lentiform nucleus. Schmahmann, Carlos S. Kase, MD; Edward Feldmann, MD; George Baquis, MD; John P. Greenberg, MD; PhillipB. The clinical course of all the patients was recorded in the acute phase (between first week and second week of onset) and chronic phase (between 6 months and 1 year). In the acute phase of stroke the patient presented a mild right clumsiness with complete recovery one week after onset. It is documented that the caudate nucleus is involved in degenerative diseases of the central nervous system such as Parkinson disease and Huntington disease. The caudate nucleus is considered part of the basal ganglia. Occlusion of these vessels therefore leads to stereotyped stroke syndromes. Verbal amnesia (patients 2 and 3), visual and verbal amnesia (patient 10), anomia (patients 6, 8, and 9), and ideomotor and buccolingual apraxia (patient 5) were other characteristics of left caudate infarcts (Table 2). Symptoms may occur suddenly, progressively, or in a fluctuating manner (e.g. 2017. from Structurally the body of the caudate nucleus forms the floor for the lateral ventricles. Subjects. Lacunar stroke syndrome (LACS) is a description of the clinical syndrome that results from a lacunar infarct. The behavioral abnormalities were mostly due to medial, lateral, and ventral caudate subnuclei damage and coexisting lesion of the anterior limb of the internal capsule. Can the inferior olive both excite and inhibit Purkinje cells? What are synonyms for caudate nucleus? One patient with right caudate infarct had motor dysprosody, motor impersistence in eye-closing, and held-up hands for 20 seconds (patient 18), and another patient had inadequate laughing at stroke onset (patient 13). (Sometimes a part of the caudate nucleus is referred to as genu). © American Heart Association, Inc. All rights reserved. Three patients with psychic akinesia had right-sided damage of the internal capsule with MCN or LCN territory infarct (patients 21, 24, and 25), and 2 patients had additional involvement of the MCN, LCN, and caudate fundus region on the left side (patients 24 and 25). Moreover, the head, which is medially separated by the septum pellucidum extends beyond the anterior part of the thalamus, stroking the telencephalic cortex. The first individual automated volumetric analysis of basal ganglia and thalamus at the Fig. MRI of caudate lesions. Nineteen patients received only antiaggregant therapy, and 6 patients underwent anticoagulation with warfarin therapy. organization. The dorsal striatum serves a function in helping mediate motor control in a person. With the putamen, the caudate nucleus forms the striatum. Keywords: Caudate nucleus, stroke, cognitive impairment, behavioral disorder, computed tomography, magnetic resonance imaging Introduction It is generally believed that mental and behav-ioral disorders can be caused by acquired fron - tal and temporal lesions. Lacunar stroke or lacunar cerebral infarct (LACI) is the most common type of ischaemic stroke, resulting from the occlusion of small penetrating arteries that provide blood to the brain's deep structures. The facial motor nucleus and its associated nerve control the labial and facial muscles and participate in the oral and pharyngeal phases of swallowing. Figure 1. and Typically, tissue plasminogen activator may be administered within 3 to 4.5 hours of stroke onset if the patient is without contraindications (i.e. Bilateral caudate nucleus infarctions are rare; a retrospective analysis of 240 cases revealed that the average incidence of bilateral caudate nucleus lesions was 1.6%. Strokes can damage brain tissue in the outer part of the brain (the cortex) or deeper structures in the brain underneath the cortex. Reference Bhatia and Marsden 1 The formation of this infarction type is mainly related to the vascular anatomy of the caudate head and variations of anterior circulation. Specifically, scientists believed it controlled movement that the person was aware of and performed consciously, rather than unconscious or reactive movement. The patient showed apathy, decreased problem solving ability, impaired memory and abstract thinking, especially the verbal memory. Synonyms for caudate nucleus in Free Thesaurus. Lesions in the posterior thalamus or lesions disrupting the dentatorubrothalamic pathway are the most common causes of tremor [24, 25 ]. The caudate nuclei are located near the center of the brain, sitting astride the thalamus. Six patients had infarct in the territory of the lateral lenticulostriate arteries, 4 patients had infarct in the territory of the anterior lenticulostriate arteries, and 1 had Heubner’s artery branch occlusion. Fifteen patients (60%) with caudate infarct and 3 patients with hemorrhage (50%) were independent. 89101112 There are few studies, however, of patients with unilateral caudate lesions that have examined long-term outcome of memory and mood disorders. Vascular topographic syndromes. the capsular warning syndrome, see transient ischemic attack). Patients with large caudate involvement, which showed deep extension (patients 3, 5, 8, and 9), had prominent motor and various neuropsychological abnormalities. use prohibited. Eight patients (33%) had large infarct of the caudate nucleus involving neighboring structure (Figure 2). This chapter reviews pertinent aspects of swallowing physiology, and the neuroanatomy and patterns of swallowing impairments with different stroke locations. 2012), and complex focal seizures (Penfield and Jasper 1954). Three major vascular areas that supply the head of the caudate nucleus were included, according to the templates of Ghika et al15 : (1) Heubner’s artery, a direct penetrating artery originating from the anterior cerebral artery and supplying the inferior part of the head of the caudate nucleus and the anterior limb of the internal capsule; (2) anterior lenticulostriate arteries originating from the proximal part of the anterior cerebral artery and supplying the anterior area of the head of the caudate nucleus; and (3) lateral lenticulostriate arteries originating from the middle cerebral artery and supplying a major part of the head of the caudate nucleus, anterior internal capsule, and putamen. Ipsilateral internal carotid artery disease (>50% stenosis or occlusion, large-artery disease) was the only potential cause of infarct in 2 patients (8%), while 2 patients had mixed etiology (1 had large-artery disease and a cardiac source of embolism [cardiac hypokinesia)], and the other had large-artery disease and NVAF). Caudate hemorrhage with moyamoya-like vasculopathy from atherosclerotic disease, Hemiballismus from hematoma in caudate nucleus, The identification of corticomotoneuronal connections, There is much information in neural network unit activations. Kumral E, Evyapan D, Balkir K. Acute caudate vascular lesions. Individually, they resemble a C-shape structure with a wider head at the front, tapering to a body and a tail. In one register study 23 , it was reported that patients with caudate stroke constituted only 1% of a total number of 3050 stroke patients (2450 ischaemic stroke and 600 haemorrhagic stroke). Acute Lesions of the Caudate Nucleus The clinical features of both ischemic and hemorrhagic strokes involving the caudate nucleus include behavioral abnormalities, dysarthria, movement disorders, language disturbances, and memory loss. the caudate nucleus head.1–13 Studies on vascular lesions (either infarct or hemorrhage) of the caudate nucleus are few. Four patients with large infarct of the caudate nucleus (patients 14, 15, 18, and 21) had prominent faciobrachiocrural paresis, predominantly in the upper limbs in 3 patients, and behavioral abnormalities. The tail of the caudate nucleus terminates immediately above the temporal horn of the ventricle. Because of the small number of cases involved, the data on clinical features according to the nuclei topography were analyzed with descriptive statistics. Damage to the caudate nucleus, putamen, and thalamus is also related to spasticity in the lower limbs of stroke patients. Subjects and Methods Background and Purpose—We sought to evaluate demographic features, risk factors, clinical profiles, and behavioral abnormalities in patients with caudate lesion, either with infarct or with hemorrhage involving the caudate nucleus. It is composed of the caudate nucleus, the putamen, the nucleus accumbens (or ventral striatum) and the globus pallidus. Symptoms and signs of internal capsule stroke include weakness of the face, arm, and/or leg (pure motor stroke). Author information: (1)1 Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea. - Among them, 3 patients developed a nonfluent type of aphasia characterized by nonfluent speech with syntax errors, repetition impairment, stuttering, word-finding difficulty, and preserved comprehension (patients 3, 6, and 9). We evaluated all patients with a diagnosis of caudate stroke admitted to Ege University Hospital Stroke Unit, Izmir, Turkey, over a 5-year period. Additionally, 1 of the 25 patients with ischemic caudate stroke (patient 5) had syphilis proved by serological test, and another patient (patient 4) had a history of Hodgkin’s lymphoma. We studied a series of patients with caudate infarcts or hemorrhages involving the head of the caudate nucleus (confirmed by CT and MRI), stroke etiology, clinical profiles, and behavioral abnormalities. Two patients (patients 24 and 25) had unilateral faciobrachiocrural paresis, predominantly in the upper limb on the side contralateral to a lesion that involved the anterior limb of the internal capsule, and psychic akinesia. Grönholm EO (1), Roll MC (2), Horne MA (2), Sundgren PC (3), Lindgren AG (1) (4). Verbal amnesia was assessed by the Rey Auditory Verbal Learning Test (trial I, with a maximum score of 15 points; a score of ≤9 indicates verbal amnesia). It predominantly uses the output neurotransmitter GABA. Patients with infarct in the territory of the right anterior lenticulostriate arteries had only neuropsychological symptoms such as confusion and abulia. Infarcts extended into the anterior limb of the internal capsule in 9 patients, and also the anterior putamen in 5 patients. These terms describe a continuum from minor to major absence of observable behavior, and despite the advanced behavioral stage, some intellectual and cognitive functions could be retained. (Sometimes a part of the caudate nucleus is referred to as genu). The caudate nucleus is located lateral to the lateral ventricles, with the head lateral to the frontal horn, and body lateral to the body of the lateral ventricle. This may be due to the disconnection of the caudate nucleus from the frontal lobe. Patients with involvement of the anterior limb of the internal capsule (patients 12, 13, 19, and 20) had predominantly faciobrachial paresis, and 1 patient (patient 13) had decreased spontaneity and speech. Further studies are required to explain the different neuropsychological findings according to caudate subnuclei. Infarcts extended into the anterior limb of the internal capsule in 9 patients, and also the anterior putamen in 5 patients. The region is innervated with dopamine neurons. The symptoms of caudate hemorrhagic stroke stabilized in <1 hour in all cases. Lacunar Stroke. Schmahmann, Carlos S. Kase, MD; Edward Feldmann, MD; George Baquis, MD; John P. Greenberg, MD; PhillipB. Functions of the lentiform nucleus. A basal ganglia stroke affects the part of the brain that controls movement, perception, and judgment. 1 synonym for caudate nucleus: caudate. Nonfluent aphasia with repetition abnormality (patients 3 and 9), transcortical motor aphasia (patient 8), and global aphasia (patient 5) occurred in patients with large caudate and deep infarct. The putamen is one of two parts of the dorsal striatum, along with the caudate nucleus. Three patients with caudate infarct had psychic akinesia (1 with right-sided lesion and 2 with bilateral lesion). caudate nucleus infarct symptoms A 75-year-old male asked: my uncle is currently in icu and his mri suggests that he has tiny acute infarcts involving left cerebeller hemisphere, left temporal lobe and right deep frontal periventricular region. The representation of egocentric space in the posterior parietal cortex, A robotics perspective on motor programs and path planning, Virtual trajectory as a solution of the inverse dynamic problem. It predominantly uses the output neurotransmitter GABA. Among them, 4 patients had isolated caudate lesions, others had involvement of the anterior limb, and only 1 had spread to the putamen. caudate nucleus infarct symptoms A 75-year-old male asked: my uncle is currently in icu and his mri suggests that he has tiny acute infarcts involving left cerebeller hemisphere, left temporal lobe and right deep frontal periventricular region. Right caudate infarcts were present in 11 patients (44%). The involved artery territory of the caudate nucleus is shown below each template. Caudate infarct occurred in 25 patients (80%) and caudate hemorrhage in 6 patients (20%) (3 patients with left and 3 with right caudate hemorrhage). 2Large-artery disease plus cardioembolism. Statistical data on risk factors and stroke mechanism were analyzed with χ2 and Fisher’s exact tests. Figure 2. Trillet et al29 observed psychic akinesia in 3 patients with apathy, flattened affect, lack of initiative for usual daily activities, stereotyped behaviors, and prolonged akinetic attacks. There were 12 abulic patients, 5 patients with right-sided caudate infarct, 3 with left-sided infarct, and 1 with bilateral caudate infarct; 3 patients with isolated caudate hemorrhage developed abulia (2 with left-sided, 1 with right-sided lesion). Within 3 weeks after stroke the patient noticed the gradual onset of involuntary simple phonic tic consisting of an “a” sound which persists. The recurrent artery of Heubner was involved in only 1 patient with syphilitic vasculitis that affected the inferior part of the caudate nucleus, the anterior part of the capsule, and the nucleus accumbens. Lacunar Stroke Guide: Causes, Symptoms and Treatment Options This site uses cookies. Fifteen patients with caudate infarct (60%) and 3 patients with hemorrhage (50%) were able to return to normal daily life. Patients with infarct in the territory of the lateral lenticulostriate arteries extending to neighboring structures showed more frequent motor and neuropsychological deficits than those with infarct in the territory of the anterior lenticulostriate arteries. Earlier studies that included caudate lesions involving neighboring anatomic structures, such as the putamen, internal capsule, and white matter, did not elucidate the clinical functions of the caudate nucleus head.12345678910111213 Studies on vascular lesions (either infarct or hemorrhage) of the caudate nucleus are few. The facial motor nucleus and its associated nerve control the labial and facial muscles and participate in the oral and pharyngeal phases of swallowing. Customer Service Small-artery disease was diagnosed in 14 patients (59%), cardiac embolism in 5 patients (20%), and large-artery disease in 2 patients (8%), and 2 patients (8%) had mixed etiology. Motor-exploratory neglect was assessed by blindfolded manual exploration described by Weintraub and Mesulam,16 which measures the exploration of ipsilesional and contralesional space by the nonparetic right hand. Another differential diagnosis that may be considered is the striatocapsular infarct, a comma-shaped infarct of the caudate nucleus, the putamen, and the anterior limb of the internal capsule. Risk factors, age, sex, and patient profiles of caudate ischemic and hemorrhagic stroke were similar to those of patients with small-artery disease and primary intracerebral hemorrhage from our registry.18 The rate of the localization of lesions was equal on both sides, and the majority of caudate infarcts were restricted to the head of the caudate nucleus without involving neighboring structures. The caudate nucleus (CN) is composed of a head, body and tail. Each of the five classical lacunar syndromes has a relatively distinct symptom complex. While the caudate nucleus has long been associated with motor processes due to its role in Parkinson's disease, it plays important roles in various other nonmotor functions as well, including procedural learning, associative learning and inhibitory control of action, among other functions. Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), Journal of the American Heart Association (JAHA), Customer Service and Ordering Information, Basic, Translational, and Clinical Research, Focused Updates in Cerebrovascular Disease, Visuospatial neglect, visual amnesia, depression, NR, headache, dysarthria, motor (face, UL>LL), CED, Abulia, verbal amnesia, impaired conflictual tasks, NR, headache, motor (face, UL>LL), disconjugated eye deviation, mydriasis, Copyright © 1999 by American Heart Association. Four abulic patients had isolated caudate lesion (patients 10, 17, 27, and 29), 4 had an extension of lesion to the capsule (patients 6, 13, 23, and 30), and 4 had a lesion that spread to the anterior putamen or to other neighboring structures in a deeper direction (patients 2, 14, 15, and 18). National Center The mechanism of abulia was explained by interruption of the limbofrontal connection. Thirteen patients had motor signs, most often a slight transient hemiparesis. Patients who present with symptoms of a lacunar stroke, but who have not yet had diagnostic imaging performed, may be described as suffering from lacunar stroke syndrome (LACS). Among dysarthric patients, infarct was limited to the caudate nucleus in 2 (patients 11 and 17), 8 patients had involvement of the anterior limb of the internal capsule, and 2 had anterior putamen involvement. Infarcts extended into the anterior limb of the internal capsule in 9 patients, and also the anterior putamen in 5 patients. Stroke in children easily causes long-term dysfunction. Motor-exploratory hemineglect may be explained by the disruption of the circuitry that relates the frontal lobe and its associative cortical regions to striatum and substantia nigra. These arteries are quite small, which makes them vulnerable to damage. This study was dedicated to Professor Julien Bogousslavsky, MD, Chief of the Department of Neurology at CHUV, Lausanne, Switzerland, who has made great and invaluable contributions to cerebrovascular science. Parkinsonism after stroke is associated with lesions in the basal ganglia (mainly striatum or lentiform nucleus) which can be unilateral or … HT indicates hypertension; DM, diabetes mellitus; NR, nuchal rigidity; UL, upper limb; LL, lower limb; CED, conjugated eye deviation; SCS, subcallosal stratum; AE, antiedema treatment; AH, antihypertensive treatment; and AVM, arteriovenous malformation. Basal ganglia. The neuropsychological findings were evaluated by measuring cognitive, language, spatial, and mnemonic functions in our neuropsychology laboratory within the first week of the stroke. Grönholm EO(1), Roll MC(2), Horne MA(2), Sundgren PC(3), Lindgren AG(1)(4). Hypertension was present in 4 patients (67%) with caudate hemorrhage, and arteriovenous malformation was present in 1 patient (17%). The topography of the head of caudate subnuclei included the lateral caudate nucleus (LCN), medial caudate nucleus (MCN), ventral caudate nucleus (VCN), and caudate fundus region, which were assessed by radiological investigations following previously published templates14 (Figure 1). It is well known that different types of aphasia, such as transcortical, nonfluent aphasia, characterized by semantic and verbal paraphasias and perseverations without comprehension impairment, occur in patients with left caudate vascular lesions.123456789101112133536 In the clinical literature, global aphasia was reported in only 1 patient with hemorrhage limited to the left caudate nucleus.12 Alexander et al3 observed that patients with subcortical lesions involving the caudate nucleus, anterior limb of the internal capsule, and putamen had word-finding difficulty or hesitancy without severe aphasic abnormalities. E-mail. We recorded risk factors for caudate stroke such as hypertension (blood pressure >160/90 mm Hgat least twice before stroke), diabetes mellitus (fasting blood glucose concentrations >6.0 mmol/L known before stroke), regular smoking, hypercholesterolemia (fasting blood cholesterol >6.5 mmol/L), venous hematocrit at admission, history of migraine, and heart disease (eg, old myocardial infarct, left ventricular aneurysm, hypokinesia or akinesia, chronic nonvalvular atrial fibrillation [NVAF], mitral stenosis). Caudate strokes September 26, 2011 jneuro Neurology Stroke 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. Motor deficit occurred in 3 patients (50%) along with conjugated eye deviation in 34% (patients 26 and 28), dysarthria (patient 28), and disconjugated eye deviation in 17% (patient 30). https://www.verywellhealth.com/what-is-the-corona-radiata-3146130 Clinical and Behavioral Findings and Prognosis of Patients With Caudate Infarct, Table 3. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Shown are coronal view (left) and horizontal view (right) of the caudate arterial territories. other findings suggest acute haemotoma in left caudate nucleus, chron Dr. John Rhoades answered Motor and visuospatial neglect were present in one fourth of the patients with right caudate vascular lesion, especially in those with a large lesion involving the internal capsule. Line cancellation and line bisection tests, which determined visuospatial function, were abnormal in 3 patients (patients 18, 21, and 26). Thirteen patients had motor signs, most often a slight transient hemiparesis.