Anosognosia for hemiplegia: a clinical-anatomical prospective study

Article Article scientifique Article Anosognosia for hemiplegia: a clinical-anatomical prospective study eng 2010 author Vocat Roland 514891 author Staub Fabienne 59371 author Stroppini Tiziano 517146 author Vuilleumier Patrik 0000-0002-8198-9214 134853 3578-3597 10.1093/brain/awq297 21126995 0006-8950 http://brain.oxfordjournals.org/content/133/12/3578.full.pdf Anosognosia for hemiplegia is a common and striking disorder following stroke. Because it is typically transient and variable, it remains poorly understood and has rarely been investigated at different times in a systematic manner. Our study evaluated a prospective cohort of 58 patients with right-hemisphere stroke and significant motor deficit of the left hemibody, who were examined using a comprehensive neuropsychological battery at 3 days (hyperacute), 1 week (subacute) and 6 months (chronic) after stroke onset. Anosognosia for hemiplegia was frequent in the hyperacute phase (32%), but reduced by almost half 1 week later (18%) and only rarely seen at 6 months (5%). Anosognosia for hemiplegia was correlated with the severity of several other deficits, most notably losses in proprioception, extrapersonal spatial neglect and disorientation. While multiple regression analyses highlighted proprioceptive loss as the most determinant factor for the hyperacute period, and visuospatial neglect and disorientation as more determinant for the subacute phase, patients with both proprioceptive loss and neglect had significantly higher incidence of anosognosia for hemiplegia than those with only one deficit or no deficits (although a few double dissociations were observed). Personal neglect and frontal lobe tests showed no significant relation with anosognosia for hemiplegia, nor did psychological traits such as optimism and mood. Moreover, anosognosia for neglect and prediction of performance in non-motor tasks were unrelated to anosognosia for hemiplegia, suggesting distinct monitoring mechanisms for each of these domains. Finally, by using a voxel-based statistical mapping method to identify lesions associated with a greater severity of anosognosia, we found that damage to the insula (particularly its anterior part) and adjacent subcortical structures was determinant for anosognosia for hemiplegia in the hyperacute period, while additional lesions in the premotor cortex, cingulate gyrus, parietotemporal junction and medial temporal structures (hippocampus and amygdala) were associated with the persistence of anosognosia for hemiplegia in the subacute phase. Taken together, these results suggest that anosognosia for hemiplegia is likely to reflect a multi-component disorder due to lesions affecting a distributed set of brain regions, which can lead to several co-existing deficits in sensation, attention, interoceptive bodily representations, motor programming, error monitoring, memory and even affective processing, possibly with different combinations in different patients. Aged Agnosia/epidemiology/*psychology Awareness/*physiology *Body Image Cohort Studies Disease Progression Female Hemiplegia/pathology/*psychology Humans Magnetic Resonance Imaging Male Middle Aged Mood Disorders/pathology/psychology Nervous System Diseases/pathology/psychology Neurologic Examination Neuropsychological Tests Perceptual Disorders/diagnosis/psychology Prospective Studies Questionnaires Regression Analysis Stroke/complications/psychology Tomography, X-Ray Computed Dewey 616.8 Dewey 616.9802 53 Département de neurosciences fondamentales 21A 52 Ecole d'éducation physique et de sport 27 false 428 Mécanismes cérébraux du comportement et des fonctions cognitives 701 Brain 133 Pt 12 96d6c817-eed0-492d-b49a-6bdd9ee88a67 Article Restricted file1.pdf 858238 application/pdf restrictedAccess Faculté de médecine / Section de médecine fondamentale / Département de neurosciences fondamentales Faculté de médecine / Ecole d'éducation physique et de sport

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Anosognosia for hemiplegia: a clinical-anatomical prospective study	Brain			2010	758	0

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Stroppini, Tiziano