Anosognosia for hemiplegia: a clinical-anatomical prospective study

Détails

ID Serval
serval:BIB_45D2DF45E5CC
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Anosognosia for hemiplegia: a clinical-anatomical prospective study
Périodique
Brain : A Journal of Neurology
Auteur(s)
Vocat R., Staub F., Stroppini T., Vuilleumier P.
ISSN
1460-2156 (Electronic)
ISSN-L
0006-8950
Statut éditorial
Publié
Date de publication
2010
Volume
133
Numéro
Pt 12
Pages
3578-3597
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
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.
Mots-clé
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
Pubmed
Web of science
Open Access
Oui
Création de la notice
13/07/2018 10:00
Dernière modification de la notice
08/05/2019 17:54
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