The chauffeur who banged cars happily: an interesting case of rapidly progressive strategic infarct dementia

Background Rapidly Progressive Dementias (RPDs) are a subtype of dementia which develop rapidly over few days to weeks or months and lead to varying neuro‐cognitive deficits. There are many causes of RPDs, like autoimmune, degenerative, metabolic, infectious, neoplastic and vascular. Majority of them are treatable if detected timely. We present an interesting case here. Method A 41 year old male who worked as a chauffeur for a senior professor was brought to the Neurology department with a rather unusual complaint. The professor said that the chauffeur has been banging his car with other cars and road dividers while driving since 3 days. When enquired, he remained unapologetic about this. Also, he had been keeping mum during conversations. On taking history from wife, it was found that he had been forgetting simple things like names, keys, food and was staying aloof. Also, there had been bouts of over aggressiveness and violent behavior with very less sleep. Examination of the patient revealed fluctuating alertness, inattention and abulia with inability to perform any higher mental function test because of uncooperativeness. There was mild right hemiparesis too. Frontal lobe involvement was ascertained and imaging done. Result MRI revealed few patchy areas of acute watershed infarcts in left frontal lobe, corona radiate, centrum semiovale and genu of corpus callosum (Figure 1). It was associated with left ICA thrombosis with significant narrowing. He was started on anti‐platelets and statins with mild improvement. He has been planned for carotid endarterectomy. Conclusion Vascular infarcts are an important cause of RPDs. Infarcts in the genu of internal capsule are notorious for causing such presentations and hence also included in ‘Strategic Infarct Dementias’ (SIDs) which are characterized by focal ischemic lesions involving specific sites that are critical for higher cortical functions. Such cases require a careful history and examination along with relevant neuroimaging for proper diagnosis and treatment. References 1. Geschwind MD, Haman A, Miller BL. Rapidly progressive dementia. Neurol Clin. 2007;25(3):783‐vii. doi:10.1016/j.ncl.2007.04.001 2. Tatemichi TK, Desmond DW, Prohovnik I, et al. Confusion and memory loss from capsular genu infarction: a thalamocortical disconnection syndrome?. Neurology. 1992;42(10):1966‐1979. doi:10.1212/wnl.42.10.1966.