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• Vol.52 No.2
• CLINICA NEUROL, 52: 96−101, 2012
• Vol.52 No.2 contents

Case Report

Liquorrhea with multiple subdural hematomas causing reversible prospagnosia

Masako Nakano, M.D. and Fujio Umehara, M.D.

Department of Neuology, Nanpuh Hospital

A 48-year-old woman presented with a 2-week history of headache. The headache was so severe in the standing position that she could hardly stand up. The results of general and neurological examination were unremarkable. MRI studies of the brain showed diffuse pachymeningeal gadolinium enhancement on the T1 weighted images. The cerebrospinal fluid (CSF) opening pressure on lumbar puncture was 70 mm H₂O. MR myelography and RI-cisternography disclosed leak of cerebrospinal fluid at the lumbar level. Then, we diagnosed her as headache associated with liquorrhea. Two weeks later, she noticed an inability to recognize familiar faces, including her own face in the mirror. The Cambridge Face Memory Test (CFMT) proved prospagnosia. Brain MRI revealed multiple subdural hematomas below the bilateral fusiform gyrus. SPECT demonstrated diffuse hypoperfusion in the brain including bilateral fusiform gyrus. Months later, she showed gradual improvement of prospagnosia. Follow-up brain MRI revealed disappearance of both subdural hematomas and diffuse pachymeningeal gadolinium enhancement. SPECT demonstrated marked improvement of cerebral blood flow in the whole brain including the right temporal-occipital lesion. This is the first report of acquired prospagnosia during the course of liquorrhea causing subdural hematomas. Subdural hematoma below a right fusiform gyrus may cause reversible prospagnosia.
Full Text of this Article in Japanese PDF (636K)

(CLINICA NEUROL, 52: 96−101, 2012)
key words: liquorrhea, prospagnosia, cambridge face memory test, fusiform gyrus, subdural hematoma

(Received: 16-Jul-11)