Neuropsychiatric Effects of Watershed Infarction: A Case Report
Poster #: 044
Session/Time: A
Author:
Jake Blendermann, BS
Mentor:
David Spiegel, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Watershed infarctions are strokes that occur in the junctions between the three major cerebral arteries. These regions are particularly vulnerable to infarction in cases of systemic hypotension or embolisms because of severe carotid artery disease. Previous literature points to a variety of behavioral and cognitive symptoms such as executive dysfunction and neurotransmitter imbalances. A notable sequelae of right parietal lobe infarction is agnosia, which is the inability to process sensory information despite preserved sensory and intellectual functioning. Watershed strokes in this region can disrupt key networks involved in visuospatial processing and body awareness. This case describes a patient who developed persistent visuospatial agnosia following a right parietal watershed infarct, with a supporting review of the literature.
CASE INFORMATION:
following a right parietal watershed infarct, with a supporting review of the literature.
METHODS:
We report the case of a 64-year-old female with no reported prior psychiatric history presented with confusion, impaired object recognition, and delirium after a documented right parietal watershed stroke associated with an aortic dissection. Comprehensive neurologic, neuropsychological, and imaging assessments were performed. A literature review was conducted to examine prior cases linking agnosia with watershed or parietal lesions and further expand on potential treatments for infarct-induced agnosia and related symptoms.
DISCUSSION:
Neuropsychological testing revealed marked visuospatial deficits and impaired recognition of objects and body schema, consistent with features of visual and asomatognosia agnosia. MRI confirmed ischemia within the right parietal watershed territory. Literature review identified several relevant cases and discussions, including described how frontal-parietal disconnection contributes to apathy and stimulus-bound behavior, both seen in agnosia, and relevant behavioral changes, such as apathy and depression, can accompany post-stroke agnosia. Other psychosocial impacts of neurobehavioral disabilities like agnosia, including frustration, social withdrawal, and loss of independence, can also occur.
CONCLUSION:
This case reinforces the link between right parietal watershed infarcts and agnosia. Recognizing agnosia as a stroke sequela is essential, as it contributes significantly to functional disability and could be mistakenly identified as or conflated with other primary cognitive or psychiatric disorders. Early identification through targeted neuropsychological testing, along with multidisciplinary rehabilitation, may improve outcomes. Further research is needed to establish best practices for screening and managing agnosia in post-stroke populations.
Watershed infarctions are strokes that occur in the junctions between the three major cerebral arteries. These regions are particularly vulnerable to infarction in cases of systemic hypotension or embolisms because of severe carotid artery disease. Previous literature points to a variety of behavioral and cognitive symptoms such as executive dysfunction and neurotransmitter imbalances. A notable sequelae of right parietal lobe infarction is agnosia, which is the inability to process sensory information despite preserved sensory and intellectual functioning. Watershed strokes in this region can disrupt key networks involved in visuospatial processing and body awareness. This case describes a patient who developed persistent visuospatial agnosia following a right parietal watershed infarct, with a supporting review of the literature.
CASE INFORMATION:
following a right parietal watershed infarct, with a supporting review of the literature.
METHODS:
We report the case of a 64-year-old female with no reported prior psychiatric history presented with confusion, impaired object recognition, and delirium after a documented right parietal watershed stroke associated with an aortic dissection. Comprehensive neurologic, neuropsychological, and imaging assessments were performed. A literature review was conducted to examine prior cases linking agnosia with watershed or parietal lesions and further expand on potential treatments for infarct-induced agnosia and related symptoms.
DISCUSSION:
Neuropsychological testing revealed marked visuospatial deficits and impaired recognition of objects and body schema, consistent with features of visual and asomatognosia agnosia. MRI confirmed ischemia within the right parietal watershed territory. Literature review identified several relevant cases and discussions, including described how frontal-parietal disconnection contributes to apathy and stimulus-bound behavior, both seen in agnosia, and relevant behavioral changes, such as apathy and depression, can accompany post-stroke agnosia. Other psychosocial impacts of neurobehavioral disabilities like agnosia, including frustration, social withdrawal, and loss of independence, can also occur.
CONCLUSION:
This case reinforces the link between right parietal watershed infarcts and agnosia. Recognizing agnosia as a stroke sequela is essential, as it contributes significantly to functional disability and could be mistakenly identified as or conflated with other primary cognitive or psychiatric disorders. Early identification through targeted neuropsychological testing, along with multidisciplinary rehabilitation, may improve outcomes. Further research is needed to establish best practices for screening and managing agnosia in post-stroke populations.