Major Cognitive Changes and Micrographia following Globus Pallidus Infarct

Abstract

Importance. Globus pallidus (GP) lesions are well known to cause motor deficits but are less commonly-and perhaps not conclusively-associated with cognitive problems. Observations. We present a 45-year-old male with no significant neurological or psychological problems who after suffering a GP infarct was subsequently found to have substantial cognitive problems and micrographia. Formal neuropsychological testing was not possible due to lack of patient follow-up. Conclusions and Relevance. Despite the conflicting literature on the association of GP lesions and cognitive deficits, our patient demonstrated significant neuropsychological changes following his stroke. In addition, evidence of micrographia likely adds to the literature on the localization of this finding. Our case thus suggests that neuropsychological testing may be beneficial after GP strokes.

Figure 1

Axial MRI of the brain. Diffusion weighted imaging sequence showing acute left globus pallidus infarct.

Figure 2

Handwriting samples. Micrographia was primarily demonstrated in the patient's right hand (designated “R”) as compared to his left hand (designated “L”).