Alterations in PDMP levels correlated with the presence of atherothrombotic lesions, and PDMP levels are expected to be useful as a clinical indicator, reflecting the presence of intracranial atherosclerotic lesions in the acute phase of cerebral infarction.
An 84-year-old right-handed man with a history of atrial fibrillation and a left parietal lobe infarct was admitted to the stroke unit due to a sudden decline in responsiveness. He was awake but silent, though his comprehension was intact. Slight weakness was noted in his right upper and lower extremities. On the third day, the patient regained his voice, but his speech was impaired with paraphasic errors and naming difficulties. Repetition was markedly impaired. The clinical findings suggested motor/conduction aphasia. An MR examination showed a left middle cerebral artery infarction involving the parietal lobe. Since both the Broca and Wernicke areas were not directly involved on the diffusionweighted imaging (DWI) study, we did MR tractography on the assumption that the left arcuate fasciculus may be damaged. These images revealed a brain infarct completely engulfing the left arcuate fasciculus, supporting the diagnosis of conduction aphasia 1 (figure; see also the video at www.neurology.org).
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