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    Invisible doppelgänger and body image disorders in right superior parietal lobule stroke, a case series
    (Wiley-VCH Verlag, 2022) Kumral, E.; Çetin, F.E.; Dere, B.; Özdemir, H.N.
    Autoscopic phenomena or an “invisible doppelgänger” refer to the illusory reduplication of one's own body. Body image disorder involves distorted perception or decreased body awareness. In the literature, feeling of presence (FOP) is rarely presented with a circumscribed cerebral pathology due to acute vascular lesions, and concomitant FOP and disorders of the body image or the body schema (BIBS) have rarely been reported. We present three cases of both FOP and BIBS disorders. All patients reported the two types of symptoms almost simultaneously: The first patient had the symptom of somatoparaphrenia characterized by deny ownership of the hand and feeling that it does not belong to her, the second patient had the sign of fading limb presented with misuse of his left hand when it was not under visual control and could not mentally represent and locate this part of the body in space, and the third patient had autotopagnosia; he was unable to localize any touched area below the elbow and knee. All patients had right parietal ischemic lesions involving the superior parietal lobule, and two patients had an adjacent additional precuneal involvement. Based on the cases presented here, it is plausible that BIBS may develop in addition to FOP, especially in lesions involving the superior parietal lobule and precuneus. © 2022 The Authors. Ibrain published by Affiliated Hospital of Zunyi Medical University and Wiley-VCH GmbH.
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    A Neuropsychiatric and Neuroimaging Study of Unilateral and Bilateral Striatal Ischemic Lesions
    (NLM (Medline), 2023) Kumral, E.; Çetin, F.E.; Özdemir, H.N.
    OBJECTIVE: Neuropsychiatric disorders after striatal territory stroke have not been studied systematically. The investigators aimed to study the spectrum of cognitive and behavioral disorders following striatal infarcts. METHODS: Different aspects of cognitive functions, including executive, frontal lobe, memory, visuospatial, language, and semantic processing, were assessed among patients with striatal infarct. Structural MRI data sets were obtained 3 months after stroke to delineate affected territories of the striatum. MRIcroGL software was used to acquire multiple layers of images, generate volume renderings, and draw volumes of interest. To determine the brain locus most frequently affected in patients with distinct cognitive disorders, ischemic area distributions in patients with cognitive dysfunction versus those without cognitive impairment were contrasted. RESULTS: Among 60 patients in this study, six different striatal infarction types were significantly associated with seven different cognitive categories (p<0.001). Unilateral caudate lesion was characterized by attention, planning, and executive disorders (38%), and unilateral lentiform infarct was characterized by executive (36%) and frontal (36%) dysfunctions. Bilateral caudate infarcts caused impairments in frontal and executive functions (75%), as well as in autobiographical (50%) and episodic (50%) memory. In those with bilateral caudate plus lentiform infarcts, all components of frontal and executive functions were dramatically impaired. The anteromedial striatum was affected more frequently in patients with language impairment compared with patients with other types of cognitive dysfunction (p<0.001). CONCLUSIONS: Following striatal stroke, a wide range of frontal-like cognitive impairments occurred, along with impaired working memory, declarative memory, executive function, speech fluency, and motor function.
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    Post-stroke aggressive behavior in patients wıth first-ever ischemic stroke: underlying clinical and imaging factors
    (Springer Science and Business Media Deutschland GmbH, 2023) Kumral, E.; Çetin, F.E.; Özdemir, H.N.; Çelikay, H.; Özkan, S.
    Background: Aggression is defined as a complex behavior consisting of a combination of sensory, emotional, cognitive and motor elements. We aimed to examine the relationships between post-stroke aggressive behavior (PSAB) and neuropsychological and neuroimaging findings. Methods: 380 patients in the stroke unit were classified as aggressive or non-aggressive based on symptoms elicited by the Neuropsychiatric Inventory (NPI) and aggression screening questionnaire. Results: Aggressive behavior was detected in 42 (11.1%) of 380 patients who had a first ischemic stroke. Patients with PSAB were older than those without (338 patients) (66.98 + 13.68 vs. 62.61 + 13.06, P = 0.043). Hamilton depression and anxiety scales showed significantly higher rates of depression and anxiety in the PSAB group compared to the non-PSAB group (47.6% vs. 16.3% and 57.1% vs. 15.4%, respectively; P = 0.001). Lesion mapping analysis showed that lesions in patients with PSAB mostly included the lower parietal lobe and lateral frontal gyrus. Multiple regression analysis showed that gender (OR, 2.81; CI%, 1.24–6.39), lateral prefrontal infarction (OR, 6.43; CI%, 1.51–27.44), parietal infarction (OR, 2.98; CI%, 1.15–7.76), occipital infarction (OR, 2.84; CI%, 1.00–8.06), multiple infarcts (OR, 5.62; CI%, 2.27–13.93), anxiety (OR, 2.06; CI%, 0.89–4.81) and verbal memory deficit (OR, 4.21; CI%, 1.37–12.93) were significant independent predictors of PSAB. Conclusion: The presence of PSAB may be related to neuropsychiatric symptoms such as high anxiety and verbal memory impairment, and neuroanatomical location of the lesions. © 2023, The Author(s) under exclusive licence to Belgian Neurological Society.