The anatomy of spatial neglect based on voxelwise statistical analysis:: A study of 140 patients
The anatomy of spatial neglect based on voxelwise statistical analysis:: A study of 140 patients
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DOI：
10.1093/cercor/bhh076
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发表时间：
2004-10-01
期刊：
影响因子：
3.7
通讯作者：
Rorden, C
中科院分区：
文献类型：
--
作者：
Karnath, HO;Berger, MF;Rorden, C
神经科患者空间忽视的解剖学研究面临的一个主要挑战是，人类病变的范围和位置在个体之间存在巨大差异。在以前的研究中，解决这个问题的方法是关注那些在中风影响的分支区域或关于现有的额外神经症状(例如，额外的视野缺陷)方面更同质性的患者亚组。可以说，这样的策略可能会对与空间忽视相关的关键底物的结论产生偏差。因此，本研究通过使用未经选择但非常大的样本量，并通过使用体素统计检验比较忽略组和非忽略组，解决了自然发生的病变固有的高变异性。我们对140例连续住院的右半球中风患者进行了为期7年的抽样调查。78人有空间忽视，62人没有表现出这种障碍。两组患者的视野缺陷发生率相似。为了评估病变的位置，在第一步，我们使用了常规的病变密度图和减影分析。此外，由于样本的大小，体素统计测试可以客观地估计与未被忽视的患者相比，忽视患者的哪些脑区更频繁地受损。结果表明，在空间忽视患者中，右侧颞叶上皮质、脑岛、皮质下壳核和尾状核是受损最多的神经结构。
A major challenge for any anatomical study of spatial neglect in neurological patients is that human lesions vary tremendously in extent and location between individuals. Approaches to this problem used in previous studies were to focus on subgroups of patients that are more homogeneous either with respect to the branch territory affected by the stroke or with respect to existing additional neurological symptoms (e.g. additional visual field defects). It could be argued that such strategies might bias the conclusions on the critical substrate associated with spatial neglect. The present study thus addressed the high variability inherent in naturally occurring lesions by using an unselected, but very large sample size and by comparing a neglect group with a non-neglect group using voxelwise statistical testing. We investigated an unselected 7 year sample of 140 consecutively admitted patients with right hemisphere strokes. Seventy-eight had spatial neglect, 62 did not show the disorder. The incidence of visual field defects was comparable in both groups. For assessing lesion location, in a first step, we used conventional lesion density plots together with subtraction analysis. Moreover, due to the large size of the sample voxelwise statistical testing was possible to objectively estimate which brain regions are more frequently compromised in neglect patients relative to patients without neglect. The results demonstrate that the right superior temporal cortex, the insula and subcortically putamen and caudate nucleus are the neural structures damaged significantly more often in patients with spatial neglect.