Disorders of visuospatial orientation in the frontal plane in patients with visual neglect following right or left parietal lesions
Disorders of visuospatial orientation in the frontal plane in patients with visual neglect following right or left parietal lesions
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DOI：
10.1007/s002210050497
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发表时间：
1998-09-01
影响因子：
2
通讯作者：
Zoelch, C
中科院分区：
文献类型：
--
作者：
Kerkhoff, G;Zoelch, C
目前的空间忽略模型集中在患者的水平或正中矢状面的缺陷。然而，其他证据表明，颞顶叶病变集中在顶叶-岛叶-前庭皮质的患者在另一个空间平面，额平面显示主观视觉垂直和倾斜方向辨别的空间知觉障碍。由于忽视和空间定向缺陷之间的关系尚不清楚，我们研究了有和没有视觉忽视的患者如何在滚动平面上执行视觉空间任务，以及他们的表现如何与忽视有关。13例患者主要是右顶叶病变和左侧忽视，14名对照患者没有忽视后，右半球的大脑病变（RBD-控制），11例患者没有忽视后，左半球的病变（LBD-控制），3例右侧忽视后，左顶叶病变，和12名正常人进行了研究。当受试者必须将发光线调整到其主观视觉垂直、主观视觉水平以及相对于倾斜定向的参考线时，用基于PC的系统测量恒定误差和差异阈值。受试者在完全黑暗的情况下坐在椅子上，头部和身体垂直于地球。左侧忽略和右侧忽略患者的三个空间方向都有明显的倾斜，大多数情况下是反向的（左侧忽略组逆时针倾斜约5度，右侧忽略组顺时针倾斜约5.5度-8.5度）。相比之下，两个病人组没有忽视，以及正常人表现出近乎完美的视觉空间判断与恒定误差小于0.8度。差异阈值显着升高，在左侧忽视的患者和右侧忽视的三个患者中的两个，而正常对照组和两个对照组的病人没有忽视进行无可争议的，有阈值的忽视患者的十分之一。所有三个空间轴的倾斜度与忽视的严重程度显著相关（无符号误差的平均r为0.74;差异阈值为0.30），表明对左右空间忽视的认知学有显著贡献。这些结果表明，虽然不一定是因果关系的空间定向缺陷之间的联系，在额叶和半球空间忽视的患者与左或右顶叶病变，超过了这些患者在水平面的证据确凿的障碍。
Current models of spatial neglect focus on deficits in the patients' horizontal ol midsagittal plane. However, other evidence suggests that patients with tempero-parietal lesions centered on the parieto-insular-vestibular cortex show disturbed spatial perception of the subjective visual vertical and oblique orientation discrimination in another spatial plane, the frontal plane. As the relationship between neglect and spatial orientation deficits is unclear, we examined how patients with and without visual neglect perform visuospatial tasks in the roll plane and how their performance is related to neglect. Thirteen patients with predominantly right parietal lesions and left-sided neglect, 14 control patients without neglect after right-hemispheric cerebral lesions (RBD-controls), 11 patients without neglect after left-hemispheric lesions (LBD-controls), 3 patients with right-sided neglect after left parietal lesions, and 12 normal subjects were investigated. Constant errors and difference thresholds were measured with a PC-based system when the subjects had to adjust a luminous line to their subjective visual vertical, subjective visual horizontal, and in relation to an obliquely oriented reference line. Subjects were oriented with their head and body earth-vertical while sitting in a chair in total darkness. Patients with left-sided as well as those with right-sided neglect showed a significant, in most cases contraversive, tilt of the three spatial orientations (about 5 degrees counterclockwise in the left neglect group and 5.5 degrees-8.5 degrees clockwise in the right neglect group). In contrast, the two patient groups without neglect as well as the normal subjects showed nearly perfect visuospatial judgements with constant errors of less than 0.8 degrees. Difference thresholds were significantly elevated in patients with left neglect and in two of three patients with right-sided neglect, whereas normal control subjects and both control patient groups without neglect performed indistinguishably, having thresholds of one-tenth of those of the neglect patients. Tilt of all three spatial axes was significantly related to the severity of neglect (mean r for unsigned errors, 0.74; for difference thresholds, 0.30), indicating a significant contribution to the symptomatology of left and right spatial neglect. These results indicate a close although not necessarily causal link between spatial orientation deficits in the frontal plane and hemispatial neglect in patients with left or right parietal lesions, surpassing the well-documented impairments of these patients in the horizontal plane.