A Case of Prosopometamorphopsia Restricted to the Nose and Mouth with Right Medial Temporooccipital Lobe Infarction that Included the Fusiform Face Area
A 75-year-old right-handed woman was admitted for the sudden onset of nausea, dizziness, and blurred vision. She had suffered from congestive heart failure, hypertension, and atrial fibrillation for more than 20 years. She had no previous history of hyperlipidemia, diabetes mellitus, or any ophthalmic disease. Routine biochemistry laboratory parameters and the full blood cell count were within normal limits. She complained of dimmed vision, and she described the central part of faces, particularly the nose and mouth, as being out of shape. Regardless of whether she looked at a familiar or an unknown person, she claimed that "the nose looks very narrow and lengthened toward the mouth, which looks small and round in shape" (). According to her description, she appeared to see faces as if viewed through a convex lens. She had no prosopagnosia; when presented with images of ten famous Korean faces (e.g., actors, singers, or the president), she was able to readily identify all of them and she could correctly recognize images of objects. She had no impairment in her visuoperceptual performances (describing a complex scene, drawing figures, reading, and writing) or in color perception. No hemineglect was found, as assessed using a line bisection or star-cancellation task and copy-drawing a flower and a clock. Other components of the neurologic examination were normal, including cranial nerves, motor and sensory functions, cerebellar function, reflexes, and gait. The rest of the physical examination was unremarkable. In particular, she had no cognitive or psychiatric impairment; the Mini-Mental State Examination and Seoul Neuropsychological Screening Battery were performed at her bedside. She copied the Rey-Osterrieth figure accurately, but had trouble recalling it. While she also had verbal memory difficulties, this was considered normal when allowing for her age. Left homonymous quadrantanopia was detected by Humphrey automated perimetry. Diffusion-weighted MRI and T2-weighted brain MRI revealed an infarction in the right medial temporooccipital lobe that included the parahippocampal gyrus (). No evidence of stenosis or occlusion of the intracranial arteries was observed on MR angiography. The patient was treated with intravenous heparin infusion and coumadization over 10 days; at the time of discharge she had recovered to the extent of near normalcy in describing faces ().