Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6487-6498
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6487
Delayed diagnosis of prosopagnosia following a hemorrhagic stroke in an elderly man: A case report
Yin Yuan, Feng Huang, Zhong-Hai Gao, Wen-Chao Cai, Jia-Xin Xiao, Yue-Er Yang, Peng-Li Zhu
Yin Yuan, Feng Huang, Jia-Xin Xiao, Yue-Er Yang, Peng-Li Zhu, Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Yin Yuan, Feng Huang, Jia-Xin Xiao, Yue-Er Yang, Peng-Li Zhu, Shengli Clinical Medical College, Fujian Medical University , Fuzhou 350100, Fujian Province, China
Yin Yuan, Feng Huang, Jia-Xin Xiao, Yue-Er Yang, Peng-Li Zhu, Fujian Provincial Institute of Clinical Geriatrics, Fuzhou 350001, Fujian Province, China
Yin Yuan, Feng Huang, Jia-Xin Xiao, Yue-Er Yang, Peng-Li Zhu, Fujian Provincial Key Laboratory of Geriatrics, Fuzhou 350001, Fujian Province, China
Yin Yuan, Feng Huang, Jia-Xin Xiao, Yue-Er Yang, Peng-Li Zhu, Fujian Provincial Center for Geriatrics, Fuzhou 350001, Fujian Province, China
Zhong-Hai Gao, Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Wen-Chao Cai, Department of Radiology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Yuan Y, Huang F, and Zhu PL contributed to the conception and design of the report; Yuan Y wrote the first draft of the manuscript; Yuan Y, Gao ZH, Cai WC, and Xiao JX contributed to the data collection and involved in manuscript writing; Huang F and Zhu PL reviewed the manuscript; all authors contributed to reviewing and revising the manuscript, read and approved the final manuscript.
Supported by Fujian Science and Technology Innovation Joint Major Project, No. 2019Y9027; and Fujian Major Projects on Science and Technology for Social Development, No. 2016YZ0001.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peng-Li Zhu, MD, Professor, Department of Geriatric Medicine, Fujian Provincial Hospital, No. 134 East Street, Fuzhou 350001, Fujian Province, China. zpl7755@hotmail.com
Received: September 20, 2020
Peer-review started: September 20, 2020
First decision: September 29, 2020
Revised: October 9, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 26, 2020
Processing time: 90 Days and 10.8 Hours
Abstract
BACKGROUND

Acquired prosopagnosia is a rare condition characterized by the loss of familiarity with previously known faces and the inability to recognize new ones. It usually occurs after the onset of brain lesions such as in a stroke. The initial identification of prosopagnosia generally relies on a patient’s self-report, which can be challenging if it lacks an associated chief complaint. There were few cases of prosopagnosia presenting purely as eye symptoms in the previous literature confirmed by functional magnetic resonance imaging (MRI).

CASE SUMMARY

We present a case of delayed diagnosis of prosopagnosia after a right hemisphere stroke in an elderly man whose chief complaint was persistent and progressive "blurred vision" without facial recognition impairment. Ophthalmic tests revealed a homonymous left upper quadrantanopia, with normal visual acuity. He was found by accident to barely recognize familiar faces. The patient showed severe deficit in face recognition and perception tests, and mild memory loss in neuropsychological assessments. Further functional MRI revealed the visual recognition deficits were face-specific. After behavioral intervention, the patient started to rely on other cues to compensate for poor facial recognition. His prosopagnosia showed no obvious improvement eight months after the stroke, which had negative impact on his social network.

CONCLUSION

Our case demonstrates that the presentation of prosopagnosia can be atypical, and visual difficulties might be a clinical manifestation solely of prosopagnosia, which emphasizes the importance of routinely considering face recognition impairment among elderly patients with brain lesions.

Keywords: Prosopagnosia; Blurred vision; Stroke; Diagnosis; Functional magnetic resonance imaging; Elderly; Case report

Core Tip: Prosopagnosia is a rare condition characterized by the loss of familiarity with previously known faces and the inability to recognize new faces. We present a case of delayed diagnosis of prosopagnosia after a right hemisphere stroke in an elderly man who only presented with progressive "blurred vision" without any facial recognition impairment. Further functional magnetic resonance imaging revealed that the visual recognition deficits were face-specific. This case report demonstrates that the presentation of prosopagnosia can be atypical, and visual difficulties could be a clinical manifestation solely of prosopagnosia. This case highlights the importance of routinely considering prosopagnosia as a potential impairment after stroke.