We have experienced a surgeon who had a previous left putaminal hemorrhage and presented with higher brain dysfunctions due to a new right frontal lobe infarction. The patient was a right-handed man in his 50s with inattention, constructive disorder, left hemispatial neglect, and executive dysfunction. The lesions were localized not only in the right inferior and middle frontal gyri but also in deep white matter including the right frontal aslant tract and superior longitudinal fasciculus. The patient gradually resumed work early on with multidisciplinary support and returned to work within 3 months after the onset of the disease. In this case, direct attention training, metacognitive strategy training including time pressure management, and visual search training from the acute stage were successful. Even after the completion of cognitive rehabilitation, an improvement in attention and processing speed was confirmed, suggesting that highly personalized cognitive rehabilitation tailored to higher brain dysfunctions have a lasting effect. However, the improvement of higher brain functions and the resumption of work increased self-awareness and anxiety, leading to a decrease in self-efficacy. Cognitive rehabilitation including metacognitive strategy training, together with psychological support, is important for step-by-step return to work.

Rehabilitation for ocular motility disorder and diplopia after acute cerebral infarction has not been established. In the present case, we describe the course of oculomotor rehabilitation in a patient with left-sided gaze palsy and diplopia due to a stroke in the paramedian part of the left pontine tegmentum. The patient was a right-handed man in his 40s. Cerebral infarction occurred after coil embolization with stenting for an unruptured dissecting aneurysm. He presented with eye movement difficulty resulting from conjugate deviation of the eyes to the right at onset. No other motor-sensory abnormalities were present. Processing speed of Wechsler Adult Intelligence Scale-Fourth Edition was decreased. We performed oculomotor rehabilitation from the acute phase, including fixation, smooth pursuit, saccadic and convergent movements. Visual attention tasks such as visual search and cancellation tasks were applied from 10 days after onset. The oculomotor disorders gradually improved and disappeared by 65 days after onset. The responsible lesion was localized in left paramedian pontine reticular formation and abducens nucleus. Medial longitudinal fasciculus was not involved, which was consistent with the clinical oculomotor findings. The neuropsychological assessments showed that processing speed was improved. Based on the neuropsychological assessments and actual vehicle evaluation, our multidisciplinary team determined that the patient should not refrain from automobile driving. The patient returned to work and resumed driving 86 days after onset. The results suggest that visual attention tasks together with basic oculomotor trainings for ocular motility disorder and diplopia are useful for early return to automobile driving and society.

Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.

Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.