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Content-Specific Delusions From Right Caudate Lacunar Stroke: Association with Prefrontal Hypometabolism

Received August 21, 2006; revised January 2 and February 7, 2007; accepted February 12, 2007. Drs. McMurtray, Sultzer, Yeo, and Mendez are affiliated with the Departments of Neurology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at the University of California at Los Angeles; Drs. McMurtray, Sultzer, Monserratt, and Mendez are affiliated with Neurology Service and Psychiatry and Mental Health Services at VA Greater Los Angeles Healthcare System in Los Angeles. Address correspondence to M.F. Mendez, Neurobehavior Unit (116AF), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073; mmendez{at}ucla.edu (e-mail).

Patients with caudate lesions can present with content-specific delusions, possibly due to disruption of frontosubcortical circuits connecting the frontal lobes with the basal ganglia. This study included eight patients who presented with content-specific delusions after right caudate stroke and an equal number of matched controls, without stroke or delusions. Compared to controls, patients with caudate lesions performed less well on tests of memory, abstract reasoning, and frontal executive functions, and had significantly reduced metabolism in the inferior prefrontal cortex. These patients suggest an etiological relationship between alterations in inferior prefrontal functions and the development of content-specific delusions.

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