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Yuan Y, Huang F, Gao ZH, Cai WC, Xiao JX, Yang YE, Zhu PL. Delayed diagnosis of prosopagnosia following a hemorrhagic stroke in an elderly man: A case report. World J Clin Cases 2020; 8:6487-6498. [PMID: 33392335 PMCID: PMC7760442 DOI: 10.12998/wjcc.v8.i24.6487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acquired prosopagnosia is a rare condition characterized by the loss of familiarity with previously known faces and the inability to recognize new ones. It usually occurs after the onset of brain lesions such as in a stroke. The initial identification of prosopagnosia generally relies on a patient’s self-report, which can be challenging if it lacks an associated chief complaint. There were few cases of prosopagnosia presenting purely as eye symptoms in the previous literature confirmed by functional magnetic resonance imaging (MRI).
CASE SUMMARY We present a case of delayed diagnosis of prosopagnosia after a right hemisphere stroke in an elderly man whose chief complaint was persistent and progressive "blurred vision" without facial recognition impairment. Ophthalmic tests revealed a homonymous left upper quadrantanopia, with normal visual acuity. He was found by accident to barely recognize familiar faces. The patient showed severe deficit in face recognition and perception tests, and mild memory loss in neuropsychological assessments. Further functional MRI revealed the visual recognition deficits were face-specific. After behavioral intervention, the patient started to rely on other cues to compensate for poor facial recognition. His prosopagnosia showed no obvious improvement eight months after the stroke, which had negative impact on his social network.
CONCLUSION Our case demonstrates that the presentation of prosopagnosia can be atypical, and visual difficulties might be a clinical manifestation solely of prosopagnosia, which emphasizes the importance of routinely considering face recognition impairment among elderly patients with brain lesions.
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Affiliation(s)
- Yin Yuan
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
- Shengli Clinical Medical College, Fujian Medical University , Fuzhou 350100, Fujian Province, China
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Center for Geriatrics, Fuzhou 350001, Fujian Province, China
| | - Feng Huang
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
- Shengli Clinical Medical College, Fujian Medical University , Fuzhou 350100, Fujian Province, China
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Center for Geriatrics, Fuzhou 350001, Fujian Province, China
| | - Zhong-Hai Gao
- Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Wen-Chao Cai
- Department of Radiology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Jia-Xin Xiao
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
- Shengli Clinical Medical College, Fujian Medical University , Fuzhou 350100, Fujian Province, China
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Center for Geriatrics, Fuzhou 350001, Fujian Province, China
| | - Yue-Er Yang
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
- Shengli Clinical Medical College, Fujian Medical University , Fuzhou 350100, Fujian Province, China
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Center for Geriatrics, Fuzhou 350001, Fujian Province, China
| | - Peng-Li Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
- Shengli Clinical Medical College, Fujian Medical University , Fuzhou 350100, Fujian Province, China
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou 350001, Fujian Province, China
- Fujian Provincial Center for Geriatrics, Fuzhou 350001, Fujian Province, China
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Darby RR, Fox MD. Reply: Capgras syndrome: neuroanatomical assessment of brain MRI findings in an adolescent patient. Brain 2019; 140:e44. [PMID: 28582487 DOI: 10.1093/brain/awx125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- R Ryan Darby
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, McLean Psychiatric Hospital, Harvard Medical School, Belmont, MA, USA
| | - Michael D Fox
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Centre for Biomedical Imaging, Charlestown, MA, USA
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