Hemispheric Disconnection Syndrome Persisting after Anterior Cerebral Artery Aneurysm Rupture

Abstract

Hemispheric disconnection syndrome is a rarely reported sequela of aneurysm rupture. Serial neurobehavioral examinations of such a patient after clipping of a right pericallosal artery that had bled into a large portion of the corpus callosum disclosed defects in interhemispheric transfer of information and competitive movements between the left and right extremities. Although the patient's postoperative memory deficit subsequently resolved, his disconnection syndrome persisted and was primarily responsible for his disability despite otherwise normal neurological findings. We studied a second patient with a hematoma in the genu of the corpus callosum secondary to an arteriovenous malformation (AVM). Although the second patient also exhibited postoperative memory problems, her hemispheric disconnection symptoms were minimal and commensurate with a more circumscribed corpus callosum lesion. Neurobehavioral sequelae of aneurysm or AVM rupture involving the anterior circulation, which may be overlooked in the absence of a detailed examination, can produce persistent disability in many patients.

Conflict of intentions due to callosal disconnection

“…The manifestations actually appeared as abnormal whole body behaviour, although Chan et al explained them by saying that the left leg would not cooperate with the right leg. With respect to such interpedal conflict, three other patients have been reported on, by Levin et al ,8 Banks et al ,9 and Della Sala et al 10 However, these patients were not included in table 1 as the abnormalities were reported to be confined to the left side.…”

Alien Hand Sign and Other Cognitive Deficits following Ruptured Aneurysm of the Anterior Communicating Artery

“…Thus in studies ofleft alien hand callosal plus extra-callosal damage are both present (e.g. Brion and Jedynak, 1972;Barbizet et at., 1978;Beukelman et al, 1980;Watson and Heilman, 1983;Levin et at., 1987). Goldberg et al (1981) account for the temporary left-sided alien hand in "pure" commissurotomy patients as a consequence of their operation which involved retraction of the non-dominant hemisphere and possible temporary disruption of the right SMA.…”