PMC4006625_01
Sudoku grid patient was completing as she had stroke. She played well initially but then could not finish the game. The incomplete puzzle shows scrawled writing (black arrow), inverted digit "3" (arrow with hash marks), and multiple incorrect attempts (white arrow).
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fig1
The game typically starts with a partially filled grid having a unique solution.) Proficient at baseline, she abruptly found herself unable to fill in the squares (Figure 1). The partially filled Sudoku shows incorrect attempts (Figure 1, open black arrow), coarse writing (Figure 1, black arrow), and the number three written as mirror image (Figure 1, hash mark arrow).
Magnetic resonance imaging (MRI) shows abnormal reduced diffusivity (a) and T2 hyperintensity (b) in the left posterior insula and temporoparietal operculum.
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fig2
Magnetic resonance imaging (MRI) performed eleven hours after onset of symptoms showed a focus of abnormal reduced diffusivity within the left posterior insula and temporoparietal operculum consistent with acute ischemic infarction (Figure 2).