Anosognosia for hemiplegia: a clinical-anatomical prospective study

Autor: Tiziano Stroppini, Fabienne Staub, Roland Vocat, Patrik Vuilleumier
Rok vydání: 2010
Předmět:
Questionnaires
Male
Neuropsychological Tests
Nervous System Diseases/pathology/psychology
Awareness/*physiology
Cohort Studies
Surveys and Questionnaires
Prospective Studies
Stroke
media_common
Neurologic Examination
Stroke/complications/psychology
Perceptual Disorders/diagnosis/psychology
Awareness
Middle Aged
Mood Disorders/pathology/psychology
Magnetic Resonance Imaging
medicine.anatomical_structure
Frontal lobe
Agnosia/epidemiology
Agnosia/psychology
Awareness/physiology
Hemiplegia/pathology
Hemiplegia/psychology
Mood Disorders/pathology
Mood Disorders/psychology
Nervous System Diseases/pathology
Nervous System Diseases/psychology
Perceptual Disorders/diagnosis
Perceptual Disorders/psychology
Stroke/complications
Stroke/psychology
Somatoparaphrenia
Agnosia
Disease Progression
Agnosia/epidemiology/*psychology
Regression Analysis
Female
Psychology
medicine.medical_specialty
media_common.quotation_subject
Hemiplegia
Neglect
Premotor cortex
Perceptual Disorders
ddc:616.9802
Physical medicine and rehabilitation
medicine
Body Image
Humans
Hemiplegia/pathology/*psychology
Aged
Mood Disorders
Anosognosia
medicine.disease
ddc:616.8
nervous system
Neurology (clinical)
Nervous System Diseases
Motor Deficit
Tomography
X-Ray Computed
Insula
Neuroscience
Zdroj: Brain, Vol. 133, No Pt 12 (2010) pp. 3578-3597
Brain : A Journal of Neurology, vol. 133, no. Pt 12, pp. 3578-3597
ISSN: 1460-2156
0006-8950
Popis: Anosognosia for hemiplegia is a common and striking disorder following stroke. Because it is typically transient and variable, it remains poorly understood and has rarely been investigated at different times in a systematic manner. Our study evaluated a prospective cohort of 58 patients with right-hemisphere stroke and significant motor deficit of the left hemibody, who were examined using a comprehensive neuropsychological battery at 3 days (hyperacute), 1 week (subacute) and 6 months (chronic) after stroke onset. Anosognosia for hemiplegia was frequent in the hyperacute phase (32%), but reduced by almost half 1 week later (18%) and only rarely seen at 6 months (5%). Anosognosia for hemiplegia was correlated with the severity of several other deficits, most notably losses in proprioception, extrapersonal spatial neglect and disorientation. While multiple regression analyses highlighted proprioceptive loss as the most determinant factor for the hyperacute period, and visuospatial neglect and disorientation as more determinant for the subacute phase, patients with both proprioceptive loss and neglect had significantly higher incidence of anosognosia for hemiplegia than those with only one deficit or no deficits (although a few double dissociations were observed). Personal neglect and frontal lobe tests showed no significant relation with anosognosia for hemiplegia, nor did psychological traits such as optimism and mood. Moreover, anosognosia for neglect and prediction of performance in non-motor tasks were unrelated to anosognosia for hemiplegia, suggesting distinct monitoring mechanisms for each of these domains. Finally, by using a voxel-based statistical mapping method to identify lesions associated with a greater severity of anosognosia, we found that damage to the insula (particularly its anterior part) and adjacent subcortical structures was determinant for anosognosia for hemiplegia in the hyperacute period, while additional lesions in the premotor cortex, cingulate gyrus, parietotemporal junction and medial temporal structures (hippocampus and amygdala) were associated with the persistence of anosognosia for hemiplegia in the subacute phase. Taken together, these results suggest that anosognosia for hemiplegia is likely to reflect a multi-component disorder due to lesions affecting a distributed set of brain regions, which can lead to several co-existing deficits in sensation, attention, interoceptive bodily representations, motor programming, error monitoring, memory and even affective processing, possibly with different combinations in different patients.
Databáze: OpenAIRE
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