Grand Rounds

摘要

Objective: Presentation of an unusual case of amnesic syndrome following a suspected AVM. The subject was a 14-year-old female (N) who suffered a large right temporo-parietal intra-parenchymal hemorrhage with extension into the ventricular system requiring surgical evacuation. She presented with a significant anterograde amnesic disorder that was generalized and not circumscribed to the visual domain. A neuropsychological assessment was recommended to investigate the nature and extent of her amnesic symptoms. Two aspects were found to be fundamental in this case, firstly, the inconsistency between the image findings of acute cerebral injury and her general amnesic disorder, and secondly, her capacity to keep up with academic demands despite persisting memory impairment. Method: N was assessed on four occasions over a period of 4 years to monitor her recovery. The initial assessment was comprehensive and covered intellectual functions, attention, processing speed, general memory, and executive functions. The subsequent reviews targeted for the most part the areas of impairment to evaluate the recovery process. Follow-up MRI findings were also reviewed. Results: The initial neuropsychological findings 5-6 weeks post-injury confirmed the presence of a moderate to severe impairment in general memory. Subsequent reviews indicated some gains overall, but she demonstrated persisting mild memory dysfunctions particularly in the area of visual memory. Conclusions: Ns general memory impairment was surprising given her right hemispheric injury. Her profile suggested some probable left hemispheric injury. Ns grades at school indicated that her mild memory impairments were not affecting her ability to keep up academically at a level that was consistent with her intellectual ability. The etiology of her memory impairment as well as the course of recovery over time will discussed.