Anosognosia and asomatognosia during intracarotid amobarbital inactivation
Anosognosia and asomatognosia during intracarotid amobarbital inactivation
复制标题
颈动脉内异戊巴比妥灭活期间的失认症和失认症
DOI：
10.1212/wnl.55.6.816
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发表时间：
2000
期刊：
影响因子：
9.9
通讯作者：
M. Nichols
中科院分区：
文献类型：
--
作者：
K. Meador;David W Loring;Todd E. Feinberg;Gregory P. Lee;M. Nichols
背景：病感失认症（即，否认轻偏瘫）和不能辨认（即，不能识别受影响的肢体是自己的）在右侧大脑损伤中更常见。然而，发病率，相对恢复和潜在机制仍不清楚。研究方法：对62例接受颈动脉异戊巴比妥手术的患者进行了病感缺失和躯体感觉缺失检查，作为癫痫手术术前评估的一部分。在最后研究的32例患者中询问了其他问题。结果如下：在非语言主导的大脑半球失活期间，62名患者中有88%的人没有意识到他们的瘫痪，82%的人在某个时候无法识别自己的手。只有3%的人没有表现出病感失认症或躯体失认症。一般而言，病感缺失比病感缺失更早消退。当病人认不出自己的手时，他们一致认为这是别人的手。在第二个系列的32例患者中观察到意识分离。虽然23名患者（72%）认为双臂都在空中，但31%的患者指出了瘫痪手臂在手术台上的正确位置。尽管32例患者中有24例（75%）无法识别自己的手，但其中21%的患者意识到自己的手臂无力，38%的患者在血管造影床上正确定位了瘫痪的手臂。结论：在急性非语言优势大脑半球功能障碍时，病觉缺失和躯体觉缺失都是常见的。对位置、虚弱和患肢的所有权的知觉分离是常见的，对位置和身体部位身份的误解也是如此。分离表明涉及多种机制。
Background: Anosognosia (i.e., denial of hemiparesis) and asomatognosia (i.e., inability to recognize the affected limb as one’s own) occur more frequently with right cerebral lesions. However, the incidence, relative recovery, and underlying mechanisms remain unclear. Methods: Anosognosia and asomatognosia were examined in 62 patients undergoing the intracarotid amobarbital procedure as part of their preoperative evaluation for epilepsy surgery. Additional questions were asked in the last 32 patients studied. Results: During inactivation of the non–language-dominant cerebral hemisphere, 88% of the 62 patients were unaware of their paralysis, and 82% could not recognize their own hand at some point. Only 3% did not exhibit anosognosia or asomatognosia. In general, asomatognosia resolved earlier than anosognosia. When patients could not recognize their hand, they uniformly thought that it was someone else’s hand. Dissociations in awareness were seen in the second series of 32 patients. Although 23 patients (72%) thought that both arms were in the air, 31% pointed to the correct position of the paralyzed arm on the table. Despite the inability of 24 of 32 patients (75%) to recognize their own hand, 21% of these patients were aware that their arm was weak, and 38% had correctly located their paralyzed arm on the angiography table. Conclusions: Anosognosia and asomatognosia are both common during acute dysfunction of the non–language-dominant cerebral hemisphere. Dissociations of perception of location, weakness, and ownership of the affected limb are frequent, as are misperceptions of location and body part identity. The dissociations suggest that multiple mechanisms are involved.