NEW-ONSET ISOLATED ACALCULIA AS A CONSEQUENCE OF RIGHT TEMPORO-PARIETO-OCCIPITAL JUNCTION INFARCT

Abstract

Introduction. Acalculia is defined as a form of cognitive impairment, manifested by the loss of ability to perform calculations and use arithmetical concepts because of the damage to some parts of the cerebral cortex, with a subcortical extension. Case presentation. We present a unique case of a 74-year-old right-handed patient with isolated acalculia on a background of ischaemic stroke in the right parietal lobe. Physical examination, laboratory tests, and various instrumental and neurological investigations including electroencephalogram and magnetic resonance imaging (MRI) were performed. Brain MRI showed a subacute infarct in the area of the right temporo- parieto-occipital junction and multiple subcortical lesions of vascular origin in the frontal and parietal lobes. The patient was treated with aspirin, enalapril, and atorvastatin, along with cognitive rehabilitation therapy. During subsequent follow-up visits, a decrease in the severity of acalculia was noticed, but complete recovery was yet to be achieved. Conclusions. Acalculia is a form of cognitive impairment, which may either be part of Gerstmann syndrome, or an isolated symptom of cognitive decline in stroke, tumours, Binswanger’s disease, several types of dementia, epilepsy, and some other diseases. However, a subacute isolated presentation is rare.

Keywords

• acalculia
• right parietal lobe infarct
• ischaemic stroke
• cognitive impairment.