A case of moyamoya disease presenting with geographic mislocation, person misidentification and fantastic confabulation

A 52-year-old woman presented with geographical mislocation (misidentification for place), person misidentification and fantastic confabulation as a result of cerebral infarction. Head MRI demonstrated a focal lesion in the right frontal lobe. Cerebral angiogram demonstrated occlusion in the circle of Willis with moyamoya vessels. The neuropsychological examination revealed memory impairment and frontal lobe dysfunction. The patient's misidentification for place and person as well as confabulation lasted for 1.5 months since admission, then gradually disappeared. We speculate that there existed a common mechanism for these three symptoms; i. e., misidentification and confabulation were based upon the impaired interpretation of the small events and partial objects in the surrounding circumstances, which might interfere with the appropriate integration and judgments of the outside information in general. The impaired monitoring and frontal dysfuction caused by the right frontal lesion appeared to be responsible for causing her deficits.