Caudal cingulate infarction manifesting astasia

Area of Science:

• Neurology
• Neuroscience
• Stroke Medicine

Background:

• Astasia, the inability to stand or walk, is a rare stroke symptom.
• Typically, astasia is associated with lesions in the ventrolateral thalamus, termed 'thalamic astasia'.
• This case explores an alternative etiology for astasia.

Observation:

• A 58-year-old male presented with profound astasia.
• Neurological examination revealed no limb motor weakness.
• Magnetic Resonance Imaging (MRI) identified cerebral infarction in the caudal cingulate gyrus.

Findings:

• Caudal cingulate infarction, specifically lesions between the vertical commissure anterior (VCA) and vertical commissure posterior (VPC) lines, can manifest as astasia.
• This specific lesion location may correspond to the human caudal cingulate zone.
• The patient's astasia symptoms persisted with reduced severity for one year.

Implications:

• Clinicians should consider caudal cingulate gyrus lesions as a potential cause of astasia.
• This expands the differential diagnosis for astasia beyond thalamic lesions.
• Recognizing astasia as a presenting symptom of stroke is crucial for timely diagnosis and management.