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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Persisting anosognosia after acute lesions is relatively rare, and no case studies to date have reported functional scanning investigation of this disorder. This is a case report of an 85-year-old right-handed Scottish woman, EN, who showed persistent anosognosia for hemiplegia following a haemorrhagic stroke. Extensive damage in the right hemisphere caused left upper and lower limb flaccid hemiplegia and severe left-sided neglect. Lack of awareness for her deficits was still present 2 years after the stroke, when neurological, neuropsychological, and SPECT examinations were performed. Testing revealed severe left unilateral neglect and poor performance on verbal fluency tasks. EN had age normal memory performance, and her object recognition and praxic abilities were preserved. She showed no global reasoning or language problems apart from her abnormal beliefs. EN believed that she was able to walk and carry out several activities, in a context of other disorders of belief. SPECT scan showed marked hypoperfusion in the right parietotemporal cortex and this extended to the associative cortex in the right frontal regions. The persistence of anosognosia in this patient cannot be explained by memory impairments or global cognitive decline. A possible account might be that alteration in awareness was maintained by contingent right frontal and/or parietal dysfunction causing a suspension or change in the ability to monitor and check the 'real' and especially to assess the veracity of mental contents.
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PMID:Belief and awareness: reflections on a case of persistent anosognosia. 1464 8

Anosognosia is a common, fascinating, and ill-understood disorder following brain damage, where patients who suffer severe deficits such as hemiplegia may remain unaware of and deny their handicap. Many studies including recent work published in this journal have attempted to determine the neurological, cognitive, and motivational bases of anosognosia. These studies have typically focused on descriptive correlations between anosognosia and various clinical factors, but did not identify a consistent pattern of brain lesion or dysfunction. Rather, the results have emphasized the complex and multifacet nature of anosognosia. This review discusses the implications of existing results, and proposes a general " framework for anosognosia where various problems in Appreciation, Belief, and Check operations may contribute to abnormal cognitive and affective appraisal of a deficit. New experimental approaches and new therapeutic tools are needed to better understand the neurocognitive mechanisms responsible for our awareness of normal functioning and failures.
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PMID:Anosognosia: the neurology of beliefs and uncertainties. 1507

This study of anosognosia for hemiplegia investigated: whether it is homogeneous; specificity to plegia of unawareness; extension to different kinds of and objects of awareness regarding plegia; partiality of unawareness. Sixty-four hemiplegic stroke patients were assessed with control subjects on (a) motor and somatosensory function, immediately followed by participants' evaluations of performance; (b) conventional structured interview questions addressing awareness of various capacities: (c) Neglect, Mental Flexibility, General Mental State, Verbal Fluency, Short-Term Memory; (d) pre- and post-performance estimates of ability on the last two; (e) estimates of current ability on bilateral and unilateral tasks, addressed by questions in 1st- and 3rd-person forms, explanations of how overestimated tasks would be accomplished, attempts at 3 bimanual tasks and post-attempt estimates of ability on these. Anosognosia for plegia was mostly associated with right-brain damage. No single factor or combination accounted for all patients. Double dissociations indicated that anosognosia can be specific to plegia: and patients do not generally overestimate other abilities. Although unawareness of paralysis and of its consequences appear linked, the latter is more widespread and persistent. Double dissociation showed that concurrent unawareness of movement failures is a separate deficit from these. There was differential awareness of different aspects of plegia. Further, some patients who overestimated current bilateral task ability when asked in 1st-person form did not overestimate when asked how well the examiner, if he was in their current condition, could do each task. This suggests split awareness of a single aspect of plegia. Patients anosognosic on conventional questioning showed two distinctions. (1) Some were unaware of movement failures when they occurred; others were aware but quickly forgot such failures and seem unable to update long-term body knowledge. (2) Some patients' explanations of bimanual task performance reflect unawareness of hemiplegia; others' explanations were bizarre and imply some awareness. The latter group's deficit appears to be nonspecific and linked to right-hemisphere predominance of anosognosia, an account of which is offered. Anosognosia for hemiplegia is not a unitary phenomenon: several factors underlie deficits in bodily awareness.
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PMID:Anosognosia for plegia: specificity, extension, partiality and disunity of bodily unawareness. 1507 1

Anosognosia for hemiplegia is the denial of the contralesional motor deficits that may follow brain damage. Although this disturbance has been reported in the neurological literature since the beginning of the last century, only few longitudinal studies have addressed the issue of the anatomical substrate of the disorder. Here we present a comprehensive review of the literature on anosognosia for hemiplegia from 1938 to 2001, taking into account some of its clinical, epidemiological and anatomical aspects. In particular, an attempt has been made to identify the intra-hemispheric lesion locations most frequently associated to the denial behaviour. Our review shows that anosognosia for hemiplegia most frequently occurs in association to unilateral right-sided or bilateral lesions of different brain areas (cortical and/or subcortical). It seems to be equally frequent when the damage is confined to frontal, parietal or temporal cortical structures, and may also emerge as a consequence of subcortical lesions. Interestingly, the probability of occurrence of anosognosia is highest when the lesion involves parietal and frontal structures in combination, if compared to other combinations of lesioned areas. This pattern of lesions suggests the existence of a complex cortico-subcortical circuit underlying awareness of motor acts that, if damaged, can give raise to the anosognosic symptoms.
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PMID:The anatomy of anosognosia for hemiplegia: a meta-analysis. 1515 94

Anosognosia for hemiplegia (AHP) is conventionally defined/diagnosed by generic questions about awareness of limb plegia. However, unawareness of inability to perform tasks requiring bilateral use of limbs is more widespread and outlasts generic unawareness of plegia. Some patients consistently overestimate bilateral task ability. Our aim was to assess how well specific questions about bilateral task ability predict whether patients consistently overestimate their abilities. Six statistical indices were calculated to rank the questions for predictiveness of consistency of overestimation of bilateral task ability. Overall, bimanual questions are better predictors than bipedal questions of consistent overestimation. Three bimanual and two bipedal questions had both sensitivity and specificity above 80%. On the basis of accuracy and discriminability, one bimanual and one bipedal question that performed maximally could be used for a quick bedside heuristic index. For a more thorough diagnostic, especially for research, five bimanual and two bipedal questions were good predictors, and should be used. For both purposes, such tests should be given in combination with conventional generic questions assessing awareness of limb plegia, since the two kinds of question reflect different kinds of unawareness of motor incapacity.
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PMID:A diagnostic test of unawareness of bilateral motor task abilities in anosognosia for hemiplegia. 1602 1

Normally, we are aware of the current functions of our arms and legs. However, this self-evident status may change dramatically after brain damage. Some patients with "anosognosia" typically are convinced that their limbs function normally, although they have obvious motor defects after stroke. Such patients may experience their own paretic limbs as strange or as not belonging to them and may even attribute ownership to another person and try to push their paralyzed limb out of bed. These odd beliefs have been attributed to disturbances somewhere in the right hemisphere. Here, we use lesion mapping in 27 stroke patients to show that the right posterior insula is commonly damaged in patients with anosognosia for hemiplegia/hemiparesis but is significantly less involved in hemiplegic/hemiparetic patients without anosognosia. The function of the posterior insular cortex has been controversially discussed. Recent neuroimaging results in healthy subjects revealed specific involvement of this area in the subject's feeling of being versus not being involved in a movement. Our finding corresponds with this observation and suggests that the insular cortex is integral to self-awareness and to one's beliefs about the functioning of body parts.
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PMID:Awareness of the functioning of one's own limbs mediated by the insular cortex? 1607 95

The psychopathology of stroke encompasses several psychiatric and behavioral disorders that have high prevalence in the geriatric population, reduce the patient autonomy and increase the caregiver's burden. These disorders are usually associated with other cognitive and neurological deficits, and are labelled as neuropsychiatric when the whole clinical picture is consistent with the specific dysfunction of a neural system or brain region. Thus the neuropsychiatry of stroke comprises disorders of the perception/identification of the self and the environment (anosognosia of hemiplegia, misidentification syndromes, confabulations, visual hallucinations, delirium and acute confusional state), amotivational syndromes (apathy and athymhormia), disorders of emotional reactivity (blunted affect, emotional incontinence, irritability, catastrophic reactions), poor impulse or ideation control (mania) and personality changes. The clinical profile of the subcortical vascular dementia also points to specific brain dysfunction (frontal-subcortical pathways) that manifests with behavioral (depression, emotionalism, irritability) and cognitive symptoms (psychomotor retardation, attention, executive and memory deficits). However, post-stroke depression and anxiety, which have a more variable clinical presentation and might be assimilated, for several aspects, to post-traumatic or adaptive disorders, are disorders less characterized in their neural correlates.
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PMID:[Psychopathology of stroke]. 1631 15

Various competing hypotheses have been put forth to explain how it is possible for patients to be unaware of their own profound weakness. We investigated whether patients' retrospections after resolution of their anosognosia along with their clinical features are consonant with these hypotheses. Three well-educated and articulate men were interviewed about their stroke and their subsequent awareness of weakness. Psychological denial, general cognitive impairment, a faulty superordinate awareness system, lack of knowledge of stroke symptoms, and minimal curiosity as a personality trait were not satisfactory explanations for their anosognosia. Their self-observations and clinical presentations suggest that: (1) anosognosia for hemiplegia can be exquisitely domain-specific; (2) weakness, rather than being perceived automatically, must be discovered; (3) discovery of weakness is impeded by a feedforward intentional deficit which probably interacts with notions of ''body schema'' in complex ways; and (4) awareness of deficit emerges in a graded fashion.
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PMID:Anosognosia for hemiplegia: patient retrospections. 1657 88

Anosognosia is the lack of awareness or the underestimation of a specific deficit in sensory, perceptual, motor, affective or cognitive functioning due to a brain lesion. This self-awareness deficit has been studied mainly in stroke hemiplegic patients, who may report no deficit, overestimate their abilities or deny that they are unable to move a paretic limb. In this review, a detailed search of the literature was conducted to illustrate clinical manifestations, pathogenetic models, diagnostic procedures and unresolved issues in anosognosia for motor impairment after stroke. English and French language papers spanning the period January 1990-January 2007 were selected using PubMed Services and utilizing research words stroke, anosognosia, awareness, denial, unawareness, hemiplegia. Papers reporting sign-based definitions, neurological and neuropsychological data and the results of clinical trials or historical trends in diagnosis were chosen. As a result, a very complex and multifaceted phenomenon emerges, whose variable behavioural manifestations often produce uncertainties in conceptual definitions and diagnostic procedures. Although a number of questionnaires and diagnostic methods have been developed to assess anosognosia following stroke in the last 30 years, they are often limited by insufficient discriminative power or a narrow focus on specific deficits. As a consequence, epidemiological estimates are variable and incidence rates have ranged from 7 to 77% in stroke. In addition, the pathogenesis of anosognosia is widely debated. The most recent neuropsychological models have suggested a defect in the feedforward system, while neuro-anatomical studies have consistently reported on the involvement of the right cerebral hemisphere, particularly the prefrontal and parieto-temporal cortex, as well as insula and thalamus. We highlight the need for a multidimensional assessment procedure and suggest some potentially productive directions for future research about unawareness of illness.
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PMID:Anosognosia for hemiplegia after stroke is a multifaceted phenomenon: a systematic review of the literature. 1753 70

The introduction of stroke units is the only well-documented cause of reduced stroke mortality during the latest decades. Factors affecting rehabilitation outcome in terms of activities of daily living includes hemiplegia, urinary and fecal incontinence, cognitive deficits and anosognosia. Physiotherapy, speech therapy and cognitive rehabilitation are indicated whenever the relevant symptoms are present, although there is insufficient knowledge of the relative efficiency of competing methods.
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PMID:[Rehabilitation of stroke patients]. 1795 65


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