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Department of Pathology (Neuropathology) (Dr. Ishii), University of Occupational and Environmental Health, Yahatanishiku, Kitakyushushi; and the Departments of Pathology and Neuropsychiatry (Drs. Nishihara and Imamura), Kurate Kyoritsu Hospital, Miyatacho, Kurategun, Fukuokaken, Japan.
We studied 30 necropsy cases of vascular dementia with a lacunar state. Manifestations included dementia, lack of volition, emotional lability, small-stepped gait, dysarthria, urinary incontinence, grasp reflex, pyramidal signs, paraplegia in flexion, and akinetic mutism. Pathologically, there was diffuse incomplete softening of white matter in all cases. Both lacunes and diffuse softening were found predominantly in the frontal lobes. The prominent clinical features were therefore frontal lobe symptoms, with good correlation between the symptoms and the distribution of pathologic lesions.
Address correspondence and reprint requests to Dr. Ishii, Department of Pathology, University of Occupational and Environmental Health, Iseigaoka 1–1, Yahatanishiku, Kitakyushushi 807, Japan.
Accepted for publication September 16, 1985.
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