Letter to the Editor
Eur Neurol 2008;59:79–82 Received: November 15, 2006
Accepted: March 17, 2007
Published online: October 11, 2008
Topographic Disorientation and
Amnesia due to Cerebral Hemorrhage
in the Left Retrosplenial Region
Aiko Osawa a Shinichiro Maeshima b Katsuzo Kunishio a
Department of Rehabilitation Medicine, Kawasaki Medical School Kawasaki Hospital, Okayama, b Department of
Rehabilitation Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
Since the report by Valenstein et al. , ferior parietal lobe and the limbic system who, due to intracerebral hemorrhage in
it has been known that a lesion in the dom- are impaired, leading to heading disorien- the left retrosplenial region, was unable to
inant retrosplenial region produces amne- tation – a disorder in which patients are learn new buildings and routes (antero-
sia. On the other hand, a lesion in the same unable to remember the direction in which grade disorientation), in addition to hav-
location in the nondominant hemisphere to go, although they are still able to recog- ing heading disorientation in familiar sur-
produces topographical disorientation . nize familiar buildings and homes . In roundings.
Specifically, connections between the in- this study, we report a case of a patient
River Bus terminal
To McDonald‘s HOME
Fig. 1. A map of the neighborhood of the patient. a The patient’s drawing. b His son’s drawing. Although the
patient could recall some names of surrounding buildings, it was impossible for him to note their positions.
© 2007 S. Karger AG, Basel Dr. Aiko Osawa
0014–3022/08/0592–0079$24.50/0 Department of Rehabilitation Medicine
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Table 1. Neuropsychological assessments
Period of assessments 2006.4 2006.5
(2 weeks) (6 weeks)
Wechsler Adult Intelligence Scale-revised
Verbal IQ 88 99
Performance IQ 76 96
Full scale IQ 82 98
Mini-Mental State Examination (/30) 12 24
Raven’s Colored Progressive
Matrices (/36) 6 23
Wechsler Memory Scale-revised
Verbal memory 59 67
Visual memory <50 79
Common sense memory <50 66
Attention/concentration <50 73
Delayed recall <50 <50
Rivermead Behavioral Memory Test
Total profile (/24) 2 8
Screening (/12) 1 3
Auditory Verbal Learning Test (/15)
Immediate recall 2-4-3-4-3 4-6-7-5-5
Recognition 3 7
Delayed recall 0 0
Frontal Assessment Battery 8 14
Behavioral assessment of the executive dysfunction system
Total profile 20: average
Word Fluency Test (/min)
Category (animal + fruit + vehicle) 5-3-2 11-7-8
Letter (‘shi’ + ‘i’ + ‘re’) 4-0-2 4-4-2
Forward 5 5
Backward 3 4
Case Report intact, although the patient had an antero- buildings with accuracy, and was also able
A 56-year-old, right-handed man was grade amnesia; he did not show confabula- to identify them on a map. However, the
admitted to our hospital on March 30, tion. He scored 12/30 in the Mini-Mental patient could not describe the route from
2006, with sudden onset of headache and State Examination, with declining perfor- the nearest bus stop to his home very well,
a narrowing visual field. His son noticed mance in orientation, attention and calcu- nor could he draw a map (fig. 1). He was
that he had begun to lose his way even in lation, and reproduction. On the Auditory able to recall the room layout in his house,
familiar surroundings, and became for- Verbal Learning Test, immediate recall (2, but made mistakes in recalling the physi-
getful of recent events several days before. 4, 3, 5, 3/15), delayed recall (0/15), and rec- cal relationship between the rooms, the
On admission, he was alert and coopera- ognition (8/15) were all decreased. On the corridors, and the entrance. When he ac-
tive. He showed right hemianopsia but no Wechsler Memory Scale, revised, verbal tually tried to walk, the patient was able to
sensorimotor loss. Neuropsychological memory quotient was 59, while the other recognize landmarks, but often got lost
examination showed recent memory loss quotient was under 50. The results of these and did not know which way to go. The
and topographical disorientation. He was tests showed that he had severe antero- patient could not learn the previously un-
aware of his memory disturbance, but ex- grade amnesia. The Wechsler Adult Intel- known hospital ward or the layout of the
pressed no serious concern. His autobio- ligence Scale-Revised scores were: verbal hospital, and often got lost finding the toi-
graphical memory for the events that had intelligence quotient (IQ) = 88, perfor- let located several meters from his room.
occurred up to the cerebral attack was ex- mance IQ = 76, and full scale IQ = 82 (ta-
cellent. For example, he could remember ble 1). He did not show aphasia, unilateral Neuroradiological Examination
the previous day’s news. Thus, he did not spatial neglect, constructional apraxia, or A cranial CT performed on the day of
exhibit retrograde amnesia. Retrograde agraphia, tactile objective anomia, ideo- onset showed a hematoma in the retrosple-
episodic memory concerning both per- motor or ideational apraxia in the bilateral nial region, diagnosed as subcortical hem-
sonal and public remote events was nearly hand. He was able to recognize familiar orrhage. Magnetic resonance imaging 3
80 Eur Neurol 2008;59:79–82 Osawa/Maeshima/Kunishio
Fig. 2. a Magnetic resonance imaging 3 days after onset showed hyperintense areas
between the left forceps occipitalis and the parietal lobe, involving the left cingu-
late isthmus. b SPECT 10 days after onset revealed a decrease in blood flow in the
left retrosplenial region.
days after onset showed hyperintense ar- Discussion of the Papez circuit. A lesion in the left
eas between the left forceps occipitalis and This case demonstrates lesions con- hemisphere is common, but a right hemi-
the parietal lobe, involving the left cingu- fined to the left retrosplenial region, with sphere lesion has also been reported, al-
late isthmus (fig. 2a). Single photon-emis- amnestic syndrome and topographical though it is rare . Regarding dysmnesia,
sion computed tomography (SPECT) 10 disorientation. There have been several ar- lesions in the left hemisphere impair ver-
days after onset revealed a decrease in ticles on retrosplenial amnesia since the bal memory, and those in the right hemi-
blood flow in the left retrosplenial region first by Valenstein et al. , and this condi- sphere impair visual memory. In this case,
(fig. 2b). tion is regarded as due to damage to a part however, although the lesions were in the
Topographic Disorientation and Eur Neurol 2008;59:79–82 81
left hemisphere, both memories were im- Regarding sequential memory, our pa- References
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82 Eur Neurol 2008;59:79–82 Osawa/Maeshima/Kunishio