Abstract
Objective Describe a perinatal parietal stroke with emotional anosognosia, presenting in adulthood.
A 46 years old female presented with imaging showing a remote right parietal infarct (superior and inferior lobules), and colpocephaly. There was a history of Congenital Rubella Syndrome (CRS), cognitive impairment and frequent near-miss motor vehicle accidents. She self-reported being an ‘unsettled child’ – in sleep and education. She had difficulty in social situations interpreting others’ intentions toward her, even her husband’s. She had difficulty with child-rearing.
Perinatal strokes occur between 20weeks gestation and 28 days postnatally, presenting catastrophically or with milder Cerebral Palsy-like picture. Asymptomatic cases may go unrecognized for many years: one cause of an ‘asymptomatic’ stroke is a right parietal lesion with ‘anosognosia’.
The parietal lobe is at the cross-roads of vision, hearing, sensation and is involved with mediating self-awareness. Right Parietal strokes can present with difficult to characterize spectrums of misperceptions in vision, hearing and emotion. However, two further considerations apply here: 1) the disturbance of parietal function had occurred preceding the development of Parieto-cortical (short and long) fibre connections, and, 2) long fascicular tracts traversing through that parietal lobe have had their connections interrupted, secondarily affecting inter-hemispheric functions.
Conclusion A prenatal right parietal stroke is rare enough that neuropsychological test ‘normal values’ would be difficult to interpret. Patients who present with longstanding neurological issues should be imaged at least once as an adult. Validated neuropsychological testing for the right parietal lobe needs to be developed to better understand this debilitating condition.
