Running out of Steam

Stroke affecting the basal ganglia not only impacts motor functions but can lead to significant cognitive and behavioural changes. This case study is of a 53-year-old lady who had acute restricted diffusion in lenticulostriate regions bilaterally, with haemorrhagic transformation more extensive on the left. On admission, there were no focal neurological signs on examination and basic functional abilities were entirely unaffected on the Barthel scale. Neuropsychological assessment however revealed significant changes in general intellect, poor verbal recall and recognition memory, and executive dysfunction. There was also significant change in behaviour and personality consistent with severe apathy. These cognitive and behavioural difficulties continued to have a significant impact on the patient’s life for months following the stroke; she required specialist vocational rehabilitation support to return to work. This case highlights the importance of cognitive screening and neuropsychological assessment in stroke care.