Visual and Cognitive Disorders Associated With Isolated Lingual Gyrus Infarctions.

Abstract

Objective: Isolated ischemic stroke of the lingual gyrus is uncommon. The authors evaluated the clinical, neuro-ophthalmological, and cognitive features of lingual gyrus infarctions.

Methods: This study was carried out from January 1, 2012, to January 30, 2022, in a hospital's stroke, neuro-ophthalmology, and neuropsychology unit, in İzmir, Turkey. Various aspects of visual and cognitive functions of 10 patients with isolated lingual infarctions were analyzed. The authors used structural MRI data to contour ischemic areas by hand and used MRIcroGL software to convert these areas to binarized images.

Results: Isolated lingual infarctions accounted for 3% of posterior cerebral artery territory infarctions. Two-thirds (N=7) of the patients had macular-sparing superior quadrantanopia with visuocognitive disturbances. One patient reported mild visual snow characterized by tiny flickering dots resembling static on an analog television screen. All six patients with right-sided lingual gyrus involvement had significant difficulties in visual memory, and three of four patients with left-sided lesions had difficulties in verbal memory. Three patients had achromatopsia, and two patients had mental color imagery impairment. One patient with topographagnosia had difficulty recognizing İzmir's landmarks and finding the city on a map.

Conclusions: The lingual gyrus is a brain structure that appears to be critical for vision processing, color integration, face recognition, visual-verbal processing, mental visual imagery, dreaming, and encoding of visual memories. The most common cause of stroke in this region was arterial-to-arterial and cardiac emboli.