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December 1988

Disorientation to Place

Arch Neurol. 1988;45(12):1299. doi:10.1001/archneur.1988.00520360017003

To the Editor.  —Orientation to person, place, and time is a traditional line of inquiry on the routine mental status examination; an impaired response is commonly attributed to a generalized encephalopathy of metabolic, toxic, nutritional, infectious, or degenerative origin. However, Fisher1 described six patients in whom acute disorientation only to place was associated with focal ischemia to the nondominant cerebral hemisphere. This observation has practical consequences, as we recently cared for a patient whose disorientation to place signaled the presence of a surgically correctable stenosis of the right internal carotid artery.

Report of a Case.  —A 68-year-old right-handed diabetic, hypertensive woman was admitted with left homonymous hemianopia. She had been followed up for a right carotid bruit and had previously under-gone transmetatarsal amputation for gangrenous ulcers of the right toes. Twelve days before admission she developed a throbbing headache and difficulty with reading, identifying her relatives by their facial appearances, and appreciating oncoming vehicles while driving. In addition to the

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