A Strategic Infarct Leading to Mild Cognitive Impairment


This case demonstrates that a strategic placed single small subcortical infarct can lead to significant cognitive impairment, in this case dysphasia resulting from a thalamic infarct. It is quite possible that a more detailed cognitive assessment by a neuropsychologist would have revealed other more subtle defects in cognitive function, given that the Montreal Cognitive Assessment is a screening tool and is not intended to be diagnostic. More extensive cognitive impairment can arise from such strategic placed infarcts particularly if they are bilateral e.g. when bilateral thalamic infarction occurs as a result of occlusion of a normal anatomical variant artery in which a single common perforating branch of the tip of the basilar artery supplies both thalami. Such strategic thalamic infarcts are recognized to cause of up to 5 % of cases of vascular dementia.


Subcortical infarct Mild cognitive impairment Dysphasia Thalamus Vascular dementia 


  1. 1.
    Pendlebury ST, Welch SJ, Cuthburtson FC, et al. Telephone assessment of cognitive function after transient ischaemic attack and stroke: modified telephone interview of cognitive status and telephone montreal cognitive assessment versus face-to-face montreal cognitive assessment and neuropsychological battery. Stroke. 2013;44(1):227–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Szirmai I, Vastagh I, Szombathelyi E, et al. Strategic infarcts of the thalamus in vascular dementia. J Neurol Sci. 2002;203–4:91–7.CrossRefGoogle Scholar
  3. 3.
    Tanaka H, Hoshino Y, Watanabe Y, et al. A Case of Strategic Infarct Mild Cognitive Impairment. Neurologist. 2012;18(4):211–13.Google Scholar
  4. 4.
    Engelter ST, Gostynski M, Papa S, et al. Epidemiology of aphasia attributable to first ever stroke. Stroke. 2006;37:1379–84.Google Scholar
  5. 5.
    Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy impact on recovery. Stroke. 2003;34:987–93.CrossRefPubMedGoogle Scholar
  6. 6.
    Gill SK, Leff A. Dopaminergic therapy in aphasia. Aphasiology. 2013;28(2):155–70. doi: 10.1080/02687038.2013.802286.PubMedCentralCrossRefGoogle Scholar
  7. 7.
    Berthier ML, Green C, Lara JP, et al. Memantine and constraint induced aphasia therapy in chronic post stroke aphasia. Ann Neurol. 2009;65:577–85. doi: 10.1002/ana.21597.CrossRefPubMedGoogle Scholar
  8. 8.
    Berthier ML, Hinojosa J, del Carmen MM, et al. Open label study of donepezil in chronic post stroke aphasia. Neurology. 2003;60(7):1218–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Pendlebury S, Rothwell PM. Prevalence, incidence and factors associated with pre stroke and post stroke dementia: a systematic review and metanalysis. Lancet Neurol. 2009;8:1006–18.CrossRefPubMedGoogle Scholar
  10. 10.
    Pendlebury ST, Mariz J, Bull L, et al. MoCA, ACE-R and MMSE versus the national institute of neurological disorders and stroke-Canadian network vascular cognitive impairment harmonisation standards neuropsychological battery after TIA and stroke. Stroke. 2012;43:464–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Chan E, Khan S, Oliver R, et al. Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA): a Study in Subacute Stroke. Journal of the Neurological Sciences. 2014;343(1–2). doi: 10.1016/j.jns.2014.05.005.
  12. 12.
    Croquelois A, Godefroy O. Aphasic, arthric, calculation and auditory disorders. In: Godefroy O, editor. The behavioural and cognitive neurology of stroke. Secondth ed. Cambridge: Cambridge University Press; 2013. p. 65–75.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Education UnitNational Hospital for Neurology and Neurosurgery, UCL Institute of NeurologyLondonUK
  2. 2.Institute of Cognitive Neuroscience and Department of Brain Repair and RehabilitationUCL Institute of Neurology, University College London and National Hospital for Neurology and NeurosurgeryLondonUK

Personalised recommendations