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. 2020 Oct 2:11:570160.
doi: 10.3389/fpsyg.2020.570160. eCollection 2020.

Reduced Self-Awareness Following a Combined Polar and Paramedian Bilateral Thalamic Infarction. A Possible Relationship With SARS-CoV-2 Risk of Contagion?

Massimo Bartoli  1 , Sara Palermo  1   2 , Mario Stanziano  3   4 , Giuseppina E Cipriani  1 , Daniela Leotta  5 , Maria C Valentini  6 , Martina Amanzio  1   2
Affiliations

Reduced Self-Awareness Following a Combined Polar and Paramedian Bilateral Thalamic Infarction. A Possible Relationship With SARS-CoV-2 Risk of Contagion?

Massimo Bartoli et al. Front Psychol. .

Abstract

Reduced self-awareness is a well-known phenomenon investigated in patients with vascular disease; however, its impact on neuropsychological functions remains to be clarified. Importantly, selective vascular lesions provide an opportunity to investigate the key neuropsychological features of reduced self-awareness in neurocognitive disorders. Because of its rarity, we present an unusual case of a woman affected by a combined polar and paramedian bilateral thalamic infarction. The patient underwent an extensive neuropsychological evaluation to assess cognitive, behavioral, and functional domains, with a focus on executive functions. She was assessed clinically in the acute phase and after 6 months from the stroke, both clinically and by magnetic resonance imaging. The patient developed a cognitive impairment, characterised by prevalent executive dysfunction associated with reduced self-awareness and mood changes, in terms of apathy and depression. Such condition persisted after 6 months. In May 2020, the patient underwent the serology test in chemiluminescence to detect IgG antibodies against SARS-CoV-2. The result of the quantitative test highlighted a high probability of previous contact with the virus. We suggest that reduced self-awareness related to executive dysfunction and behavioral changes may be due to combined polar and paramedian bilateral thalamic lesion. Metacognitive-executive dysfunction affecting the instrumental abilities of everyday life might make people less able to take appropriate precautions, facilitating the risk of SARS-CoV-2 contagion.

Keywords: SARS-CoV-2; case study; executive functions; polar and paramedian thalamic infarction; reduced self-awareness.

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Figures

FIGURE 1
FIGURE 1
Magnetic resonance imaging (MRI) shows lacunar thalamic infarcts symmetrically located within the polar and paramedian vascular territories of both thalami. Lesions are well-demarcated and isointense to cerebrospinal fluid as observed in chronic settings. The anatomical symmetry was the distinctive feature in this patient.
See this image and copyright information in PMC

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