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Brain, Vol. 111, No. 3, 507-524, 1988
© 1988 Guarantors of Brain

research-article

ACUTE PSEUDOBULBAR MUTISM DUE TO DISCRETE BILATERAL CAPSULAR INFARCTION IN THE TERRITORY OF THE ANTERIOR CHOROIDAL ARTERY

CATHY HELGASON1,, ANDREW WILBUR2, ANNE WEISS3, KATHLEEN J. REDMOND4 and NANCY A. KINGSBURY5

13From the Department of Neurology, University of Illinois Medical Center at Chicago Chicago, Illinois, USA 2From the Department of Radiology and University of Illinois Medical Center at Chicago Chicago, Illinois, USA 45From the Department of Otolaryngology—Head and Neck Surgery, University of Illinois Medical Center at Chicago Chicago, Illinois, USA

Correspondence to: Correspondence to: Dr Cathy M. Helgason, Department of Neurology, University of Illinois Medical Center at Chicago, 912 S. Wood Street, Chicago, Illinois 606 12, USA.

Pseudobulbar mutism is rarely attributed to bilateral discrete posterior limb internal capsule-medial globus pallidus infarction. Few cases of bilateral anterior choroidal (AchA) artery territory infarction have been reported. We present 8 patients with ischaemic stroke in this location and vascular distribution who have a characterizable syndrome. All had the abrupt onset of inability to speak, swallow or phonate, accompanied by varying degrees of facial diplegia, hemiparesis, hemisensory loss, lethargy, neglect and change in affect. The appearance of clinical signs depends upon the presence of a new infarct contralateral to an older lesion in mirror position. The pathogenesis and progression of neurological deficit appears to be intimately related to hypertension. The role of intrinsic intracranial vascular pathology related to diabetes mellitus, embolism of cardiac origin and atherosclerosis is currently undefined. The prognosis for recovery is poor. Half of our patients died within a year of onset of symptoms. Capsular pseudobulbar mutism is recognized by the abrupt appearance of neurological deficit consistent with internal capsular pathology and is confirmed by CT scan or MRI.

Received May 18, 1987. Revised August 4, 1987. Accepted September 1, 1987.


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