Ischemic stroke of the left claustrum in a 55-year-old female: a case report

Abstract

Background: The claustrum is a brain structure found in both hemispheres beneath the inner surface of the neocortex in the region of the insula and is bordered by the external and extreme capsule. Generally, it is divided into a dorsal part (claustrum proper or insular claustrum) and ventral part (endopiriform nucleus). The claustrum possesses complex reciprocal connections with the cortex, striatum, dorsal thalamic nuclei and hippocampus. Reports of patients with unilateral lesion of the claustrum are few in number. Herein, we present a case report of an ischemic stroke restricted to the left claustrum in a 55-year-old female Case Report: The patient presented with intense feeling of dizziness, ataxic gait, sensation of 'vacuity' in the head, decreased hearing and abnormal gustatory sensations. The neurological examination revealed a mixed horizontal and rotary nystagmus to the right side. Brain CT upon admission was assessed as normal without pathological findings. MRI was performed and showed an ischemic stroke restricted to the left claustrum with no other lesions. Following 4 weeks of therapy the patient recovered fully and duplex sonography showed preserved circulation in the affected areas. Conclusion:The present case report underlines the complexity of clinical symptomatology of the claustrum.

Human lesions and animal studies link the claustrum to perception, salience, sleep and pain

“… 46 A 55-year-old patient with an isolated left claustrum lesion following an ischaemic stroke experienced unilateral paraesthesia of the face, tongue, and head—similar to a lacunar syndrome—along with polymodal gustatory, auditory, vestibular, and visual disturbances. 47 Recently, a patient admitted to hospital with Covid-19 showed bilateral lesions to the claustrum and external capsule. He presented with aggression, cognitive impairment, disorientation, and stupor.…”

“…Somatosensory deficits have also been reported. 47 , 52 Cases presumed to be driven by encephalitis often presented with deficits in episodic memory, 46 , 53 , 54 working memory, and reasoning or with disorientation in time. 52 Claustrum damage has even been described as part of neurodegenerative syndromes such as corticobasal degeneration, where it may be accompanied by a disruption in visual attention functions including spatial orientation, optic ataxia, 55 and cognitive decline in Lewy body dementia.…”

“…80 , 82 Pain with hypoaesthesia has also been reported. 81 Other cases have described dynamic changes, such as painful cramping beginning in the contralateral hand, with Jacksonian march to the whole of the left side, 79 or discomfort with spreading paraesthesia, 47 suggesting that pain could relate to heightened excitability rather than neural loss.…”

Does the claustrum have a function? Lessons from human lesion and animal studies point to divergent multifunctionality

“…Another patient with abnormalities in the right claustrum and bilateral external capsule experienced non-epileptiform EEG abnormalities, along with motor and cognitive impairment (Hwang et al, 2014). A 55-year-old patient with an isolated left claustrum lesion following an ischaemic stroke experienced unilateral paraesthesia of the face, tongue, and head -similar to a lacunar syndrome -along with polymodal gustatory, auditory, vestibular, and visual disturbances (Maximov et al, 2018). Recently, a patient admitted to hospital with Covid-19 showed bilateral lesions to the claustrum and external capsule.…”

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