A Case of Bilateral Globus Pallidus Infarction Onset With Mental Disorder.

Abstract

Bilateral globus pallidus lesions are closely linked to neuropsychiatric manifestations; however, bilateral globus pallidus infarction is frequently misdiagnosed owing to its nonspecific clinical presentation. We report a 45-year-old female patient who initially presented with mental disturbance (akinetic mutism, memory impairment, and sleep rhythm disorder) without typical motor deficits. Comprehensive head and neck imaging (including DSA, CTA, and multimodal MRI) combined with extensive laboratory investigations-excluding metabolic, toxic, and inflammatory etiologies-led to the final diagnosis of bilateral symmetric globus pallidus infarction secondary to bilateral internal carotid artery dissection (ICAD). Notably, the patient had a recent neck massage, which may have precipitated ICAD. Following dual antiplatelet therapy and endovascular stent placement for severe left ICA stenosis, the patient achieved significant clinical improvement at 2-month follow-up. This case highlights the potential association between neck massage and ICAD-induced bilateral globus pallidus infarction and emphasizes the importance of multimodal imaging in differentiating vascular mental disorders from primary psychiatric illnesses. Our findings provide new insights into the clinical spectrum and pathogenic mechanisms of this rare condition, aiming to facilitate early recognition and targeted management by clinicians.