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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dysfunction of higher cortical function and neurobehavioral syndromes may be present in up to 87% of stroke patients. These symptoms may occur less often in patients with transient ischemic attacks (36%). Approximately 22% of stroke patients may present only with cognitive and neurobehavioral symptoms without elementary neurological deficits. In this chapter we concentrate on delusions, hallucinations, misidentification syndromes, anosognosia of hemiplegia, aggressive behavior and also extended self syndrome.
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PMID:Neurobehavioral syndromes. 2237 64

Strategic regions correspond to associative, limbic and paralimbic structures and related circuits, that underpin cognitive/behavioral functions. Strokes in these eloquent sites produce pictures of vascular dementia with syndromic features due to specific site lesion and/or interruption of their interconnections. This study aims at analysing subcortical strategic strokes that express similar cognitive/behavioral elements, by sharing common pathways. Patients (n=6) who attended in specialized ambulatory, were submitted to neuropsychological and neuroimaging assessments through MRI (GE Signa Horizon 1.5T) and brain SPECT (Millennium MG, ECD [TC-99m]). Stroke locations and respective main symptoms were: 1. anteromedian thalamus [L]: anterograde and retrograde amnesia (ARA), expression aphasia (EA), executive dysfunction (ED), apathy, and depression; 2. anterior thalamus [R]: ARA, inattention, apathy, and aggressiveness; 3. dorsomedian thalamus [L]: inattention, ED, anosognosia, and aggressiveness; 4. central paramedian thalamus [R]: EA, visual perception deficits (VPD), ED, infantility, and personality disorder; 5. caudate nucleus (ventral-head) [L]: VPD, ED, delirium, visual hallucinations, and personality disorder; and 6. anterior capsule [L]: VPD, ED, apathy, and depression. Vascular strategic syndromes connote the predominantly impaired cognitive/behavioral symptom of each site. Temporal and frontal disconnection symptoms were produced by disrupted MTT/hippocampal and IML/amygdala circuits expressing amnesic syndrome associated with heterogeneous dysexecutive syndrome, in all the cases, by disrupting frontal-basal ganglia-thalamus-cortical net, in three different levels of their pathway.
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PMID:Cognitive disconnective syndrome by single strategic strokes in vascular dementia. 2293 18

The following case report discusses a 21-year-old Hispanic woman who was brought to the emergency room for evaluation because of experiencing acute left-sided hemiparesis with anosognosia. Upon further assessment, the patient was found to have a positive blood test for methamphetamines, positive human chorionic gonadotropin for pregnancy, and a history of patent foramen ovale. Neurological examination of the patient revealed left hemiparesis, dysarthria, and homonymous hemianopsia of the left side with a National Institutes of Health Stroke Scale of 12. Given the patient's assessment and positive radiological findings of a clot located within the right M1 segmental branch of the middle cerebral artery territory through the use of computed tomography angiography, deployment of intra-arterial thrombolytics within 6 hours of symptom onset was utilized. The patient's clinical course was complicated by brain swelling requiring intubation. Return of neurological function was assessed with noninvasive and invasive neurological evaluation, which showed full cognitive and physical return of the functional baseline level at discharge.
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PMID:Intra-arterial tissue plasminogen activator for an ischemic stroke in a 21-year-old Hispanic woman with elevated beta human chorionic gonadotropin and complex clinical history. 2375 49

We describe behavioral and neuropsychological outcome of a patient (N.S.), who showed a bilateral paramedian thalamic ischemic lesion, with particular reference to the longitudinal evolution of topographical disorientation (TD) and confabulations. We report clinical neuropsychological/behavioral data over a 43-month follow-up. The results show early after the stroke a severe amnesic-confabulatory syndrome with dysexecutive deficits, associated with memory disorders both for visuo-spatial and verbal materials and TD both for known and new places. Behavioral disinhibition and anosognosia for cognitive deficits were also observed. All cognitive impairments have been recovered during the long-term follow-up. Bilateral paramedian thalamic infarcts often lead to severe and long-lasting neurological and cognitive impairments. Only a few cases showed good recovery. Our patient represents an interesting and uncommon case of bilateral paramedian thalamic syndrome with a significant neuropsychological recovery.
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PMID:Cognitive and behavioral deficits following bilateral thalamic stroke: a longitudinal study. 2398 Aug 18

When humans move simultaneously both hands strong coupling effects arise and neither of the two hands is able to perform independent actions. It has been suggested that such motor constraints are tightly linked to action representation rather than to movement execution. Hence, bimanual tasks can represent an ideal experimental tool to investigate internal motor representations in those neurological conditions in which the movement of one hand is impaired. Indeed, any effect on the "moving" (healthy) hand would be caused by the constraints imposed by the ongoing motor program of the 'impaired' hand. Here, we review recent studies that successfully utilized the above-mentioned paradigms to investigate some types of productive motor behaviors in stroke patients. Specifically, bimanual tasks have been employed in left hemiplegic patients who report illusory movements of their contralesional limbs (anosognosia for hemiplegia). They have also been administered to patients affected by a specific monothematic delusion of body ownership, namely the belief that another person's arm and his/her voluntary action belong to them. In summary, the reviewed studies show that bimanual tasks are a simple and valuable experimental method apt to reveal information about the motor programs of a paralyzed limb. Therefore, it can be used to objectively examine the cognitive processes underpinning motor programming in patients with different delusions of motor behavior. Additionally, it also sheds light on the mechanisms subserving bimanual coordination in the intact brain suggesting that action representation might be sufficient to produce these effects.
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PMID:Bimanual coupling paradigm as an effective tool to investigate productive behaviors in motor and body awareness impairments. 2420 39

"Implicit awareness" may be inferred from compliance with medical treatment, even when the patient explicitly denies the need for treatment. Such compliance may cause medics and other health professionals to underestimate the frequency of anosognosia and its effects on the lives of patients and carers. We report survey data showing that health professionals do indeed consider anosognosia following stroke to be relatively uncommon and unimportant, in contrast with evidence on its true frequency and impact. Mograbi and Morris' emphasis on the distinction between implicit and explicit awareness may promote increased recognition of anosognosia amongst health professionals.
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PMID:Health professionals are unaware of anosognosia. 2425 6

Patients with anosognosia for visual field defect (AVFD) fail to recognize consciously their visual field defect. There is still unclarity whether specific neural correlates are associated with AVFD. We studied AVFD in 54 patients with acute stroke and a visual field defect. Nineteen percent of this unselected sample showed AVFD. By using modern voxelwise lesion-behaviour mapping techniques we found an association between AVFD and parts of the lingual gyrus, the cuneus as well as the posterior cingulate and corpus callosum. Damage to these regions appears to induce unawareness of visual field defects and thus may play a significant role for conscious visual perception.
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PMID:Anosognosia for obvious visual field defects in stroke patients. 2465 82

This review provides an overview of research into anosognosia after stroke over the past 35 years. We are specifically interested in the assessment of anosognosia in group studies and in how any changes in assessment procedures have impacted the study of anognosia. Our work is based on a systematic review of reports drawn from electronic databases covering the period from 1978 to 2013 (CINAHL, PubMedMEDLINE, PsycINFO, Web of Knowledge). Sixty-four articles met the selection criteria. The results of our review show that a deeper understanding has evolved of the multifaceted syndrome of anosognosia during the past decade. The most recent studies made more extensive use of research, observational and performance-based procedures as well as traditional interview methods. Modality specificities and patients with language impairment also receive closer consideration than earlier. Furthermore, the results are more often obtained from homogeneous patient groups. The limitations of recent anosognosia research include the diversity of assessment methods used and the variation in the assessment times between and within patient groups, and the tendency to rely on only 1 method to assess and diagnose anosognosia. In order to improve the comparability of anosognosia studies it would be useful to have guidelines for the number and type of assessment methods used in studying different subtypes of anosognosia, and to focus on homogeneous patient samples. Furthermore, it is recommended that more research be done to explore chronic anosognosia and its impact on daily living.
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PMID:Assessing anosognosias after stroke: a review of the methods used and developed over the past 35 years. 2491 51

Anosognosia for hemiplegia (AHP), or unawareness of motor deficits contralateral to a brain lesion, has lasting negative implications for the management and rehabilitation of patients. A recent, bedside psychophysical intervention, namely self-observation by video replay, lead to a lasting remission of severe AHP in an acute stroke patient (Fotopoulou, A., Rudd, A., Holmes, P., & Kopelman, M. (2009). Self-observation reinstates motor awareness in anosognosia for hemiplegia. Neuropsychologia, 47, 1256-1260). This procedure has been adjusted and applied here, as the basis of two intervention protocols administered independently to two patients with severe AHP. The first study used multiple, successive sessions of video-based self-observation in an acute patient, targeting first the awareness of upper limb and subsequently lower limb paralysis. The second study used a single session of video-based, self- and other-observation in a patient at the chronic stage following onset. Both protocols also involved elements of rapport building and emotional support. The results revealed that video-based self-observation had dramatic, immediate effects on awareness in both acute and chronic stages and it seemed to act as an initial trigger for eventual symptom remission. Nevertheless, these effects did not automatically generalise to all functional domains. This study provides provisional support that video-based self-observation may be included in wider rehabilitation programmes for the management and restoration of anosognosia.
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PMID:Another perspective on anosognosia: Self-observation in video replay improves motor awareness. 2495 30

Anosognosia for hemiplegia (AHP) is characterized as a disorder in which patients are unaware of their contralateral motor deficit. Many current theories for unawareness in AHP are based on comparator model accounts of the normal experience of agency. According to such models, while small mismatches between predicted and actual feedback allow unconscious fine-tuning of normal actions, mismatches that surpass an inherent threshold reach conscious awareness and inform judgments of agency (whether a given movement is produced by the self or another agent). This theory depends on a threshold for consciousness that is greater than the intrinsic noise in the system to reduce the occurrence of incorrect rejections of self-generated movements and maintain a fluid experience of agency. Pathological increases to this threshold could account for reduced motor awareness following brain injury, including AHP. The current experiment tested this hypothesis in healthy controls by exposing them to training in which noise was applied the visual feedback of their normal reaches. Subsequent self/other attribution tasks without noise revealed a decrease in the ability to detect manipulated (other) feedback compared to training without noise. This suggests a slackening of awareness thresholds in the comparator model that may help to explain clinical observations of decreased action awareness following stroke.
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PMID:Noisy visual feedback training impairs detection of self-generated movement error: implications for anosognosia for hemiplegia. 2507 1


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