Extensive metabolic and neuropsychological abnormalities associated with discrete infarction of the genu of the internal capsule

Objective-The clinical presentation of capsular genu infarct varies. Promin ent faciolingual weakness and subcortical dementia are the rule, but sympto ms depend on the precise location and extension of the lesion beyond the ge nu. The aim was to characterise the radiographic, electroencephalographic, and neuropsychometric abnormalities in a woman who had a history of recurre nt transient memory loss. Method-Case report. Results-Magnetic resonance imaging showed an infarct in the genu of the lef t internal capsule. Positron emission tomography scan demonstrated decrease d metabolic activity in the ipsilateral temporal, occipitotemporal, and con tralateral cerebellar hemispheres. Electroencephalography showed intermitte nt rhythmic delta activity in the left frontotemporal region, and findings on neuropsychometric evaluation were consistent with cognitive impairment. Follow up evaluation 7 months after the stroke showed improvement in some a reas of the cognitive domain, but residual neuropsychometric and neurophysi ological abnormalities persisted. Conclusion-This case illustrates that cerebral and cerebellar diaschisis ma y contribute to the symptomatic presentation and recovery from capsular gen u infarct, although its precise role remains elusive.