Visual agnosia and prosopagnosia secondary to melanoma metástases: Case report

Frota, Norberto Anízio Ferreira; Pinto, Lécio Figueira; Porto, Claudia Sellitto; Aguia, Paulo Henrique Pires de; Castro, Luiz Henrique Martins; Caramelli, Paulo

doi:10.1590/S1980-57642008DN10100016

Abstract

The association of visual agnosia and prosopagnosia with cerebral metastasis is very rare. The presence of symmetric and bilateral cerebral metastases of melanoma is also uncommon. We report the case of a 34 year-old man who was admitted to hospital with seizures and a three-month history of headache, with blurred vision during the past month. A previous history of melanoma resection was obtained. CT of the skull showed bilateral heterogeneous hypodense lesions in the occipito-temporal regions, with a ring pattern of contrast enhancement. Surgical resection of both metastatic lesions was performed after which the patient developed visual agnosia and prosopagnosia. On follow-up, he showed partial recovery of visual agnosia, while prosopagnosia was still evident. The relevance of this case is the rare presentation of metastatic malignant melanoma affecting homologous occipito-temporal areas associated with prosopagnosia and associative visual agnosia.

Key words:
prosopagnosia; visual agnosia; metastasis; melanoma.

Resumo

A associação de agnosia visual e prosopagnosia com metástase cerebral são muito raras. A presença de lesões metastáticas de melanoma, simétricas e bilaterais, também é incomum. Nós descrevemos o caso de um homem de 34 anos que foi admitido no hospital com convulsões e uma história de cefaléia há três meses, com dificuldade visual no último mês. História pregressa revelava ressecção de melanoma. TC de crânio evidenciou lesões hipodensas, heterogêneas, bilaterais nas regiões occipito-temporais, com captação de contraste anelar. A ressecção cirúrgica de ambas as metástases cerebrais foi realizada e o paciente desenvolveu agnosia visual e prosopagnosia após o procedimento. Na evolução houve melhora parcial da agnosia visual enquanto a prosopagnosia ainda estava evidente. A relevância deste caso consiste na apresentação rara de melanoma maligno metastático afetando as áreas occipito-temporais homólogas associada com prosopagnosia e agnosia visual associativa.

Palavras-chave:
prosopagnosia; agnosia visual; metastase; melanoma.

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References

¹
Damasio AR, Tranel D, Rizzo M. Disorders of complex visual processing. In: Mesulam MM, editor. Principles of behavioral and cognitive neurology. 2th ed. New York: Oxford University; 2000:332-372.
²
Farah MJ, Feinberg TE. Visual object agnosia. BehavioralNeurology and Neuropsychology. New York: Mc GrawHill;1997:239-244.
³
De Renzi E. Prosopagnosia. In: Farah MJ, Feinberg TE, editors. Behavioral Neurology and Neuropsychology. Bew York: Mc Graw Hill; 1997:245-255.
⁴
De Renzi E. Disorders of visual recognition. Semin Neurol2000;20:479-485.
⁵
De Renzi E, Perani D, Carlesimo GA, Silveri MC, Fazio F.Prosopagnosia can be associated with damage confined to the right hemisphere--an MRI and PET study and a review of the literature. Neuropsychologia 1994;32:893-902.
⁶
Klos KJ, O'Neill BP. Brain metastases. Neurologist 2004;10:31-46.
⁷
Delattre JY, Krol G, Thaler HT, et al. Distribution of brainmetastases. Arch Neurol 1988;45:741-744.
⁸
Seron X, Mataigne F, Coyette F, Rectem D, Bruyer R, LaterreEC. A case of metamorphopsia restricted to faces and different familiar objects. Rev Neurol 1995:151:691-698.
⁹
Yamamot T, Wada Y. Selective impairment of facial recognition due to a haematoma restricted to the right fusiform and lateral occipital region. J Neurol Neurosurg Psychiatr. 2001;71:254-257.
¹⁰
Rossion B, Caldara R, Seghier M, Schuller AM, Lazeyras F,Mayer E. A network of occipito-temporal face-sensitive areas besides the right middle fusiform gyrus is necessary for normal face processing. Brain 2003;126:2381-2395.

Publication Dates

Publication in this collection
Jan-Mar 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Damasio AR, Tranel D, Rizzo M. Disorders of complex visual processing. In: Mesulam MM, editor. Principles of behavioral and cognitive neurology. 2th ed. New York: Oxford University; 2000:332-372.

[2] ²
Farah MJ, Feinberg TE. Visual object agnosia. BehavioralNeurology and Neuropsychology. New York: Mc GrawHill;1997:239-244.

[3] ³
De Renzi E. Prosopagnosia. In: Farah MJ, Feinberg TE, editors. Behavioral Neurology and Neuropsychology. Bew York: Mc Graw Hill; 1997:245-255.

[4] ⁴
De Renzi E. Disorders of visual recognition. Semin Neurol2000;20:479-485.

[5] ⁵
De Renzi E, Perani D, Carlesimo GA, Silveri MC, Fazio F.Prosopagnosia can be associated with damage confined to the right hemisphere--an MRI and PET study and a review of the literature. Neuropsychologia 1994;32:893-902.

[6] ⁶
Klos KJ, O'Neill BP. Brain metastases. Neurologist 2004;10:31-46.

[7] ⁷
Delattre JY, Krol G, Thaler HT, et al. Distribution of brainmetastases. Arch Neurol 1988;45:741-744.

[8] ⁸
Seron X, Mataigne F, Coyette F, Rectem D, Bruyer R, LaterreEC. A case of metamorphopsia restricted to faces and different familiar objects. Rev Neurol 1995:151:691-698.

[9] ⁹
Yamamot T, Wada Y. Selective impairment of facial recognition due to a haematoma restricted to the right fusiform and lateral occipital region. J Neurol Neurosurg Psychiatr. 2001;71:254-257.

[10] ¹⁰
Rossion B, Caldara R, Seghier M, Schuller AM, Lazeyras F,Mayer E. A network of occipito-temporal face-sensitive areas besides the right middle fusiform gyrus is necessary for normal face processing. Brain 2003;126:2381-2395.

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