Dissociation of anosognosia for hemiplegia and aphasia during left-hemisphere anesthesia

  title={Dissociation of anosognosia for hemiplegia and aphasia during left-hemisphere anesthesia},
  author={Joshua I. Breier and John C. Adair and M. Gold and Eileen B. Fennell and Robin L. Gilmore and Kenneth M. Heilman},
  pages={65 - 67}
Article abstract-The stroke literature indicates that the explicit denial of hemiplegia, a form of anosognosia, is associated more commonly with right- than left-hemisphere lesions. Some investigators have suggested that this asymmetry may be an artifact and that the aphasia that often accompanies left-hemisphere dysfunction may mask some instances of anosognosia. Mechanisms suggested for anosognosia have been either "global" or "modular" in nature. Mechanisms posited in global explanations… 

The Anatomy of Anosognosia for Hemiplegia: A Meta-Analysis

Anosognosia for hemiparesis after left-sided stroke

Anosognosia for Motor Impairment Following Left Brain Damage

Results suggest that the frequency of anosognosia in left brain damaged patients may have been underestimated due to methodological reasons, and that anos Cognosia for motor impairment can also be associated with lesions of the left hemisphere.

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It is suggested 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.

Denial of Illness

This chapter first reviews the most common forms of anosognosia for different domains of deficits and then focuses on denial of hemiplegia, suggesting a role of multiple component deficits affecting not only motor control, attention, or proprioception but also emotional and self-monitoring systems implicated in error detection as well as belief formation and updating.

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  • Psychology, Biology
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It is suspected that anosognosia of hemiplegia might be caused by several of the mechanisms that have been proposed to explain this deficit, and it is inferred that normal self-awareness is dependent on several parallel processes.

Anosognosia and asomatognosia during intracarotid amobarbital inactivation

Dissociations of perception of location, weakness, and ownership of the affected limb are frequent, as well as misperceptions of location and body part identity, which suggest that multiple mechanisms are involved.



Anosognosia during Wada testing

The results suggest that anosognosia is more often associated with right rather than left-hemisphere dysfunction and that it cannot be attributed to either psychological denial or the emotional changes associated with hemispheric dysfunction.

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Anosognosia (denial of weakness) and "anosognosic phenomena" (other abnormal attitudes to a weak limb) were studied in 100 acute hemiplegics; explanations in terms of "unilateral neglect" and "agnosia" are discussed.

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The various phenomena of denial are linked together by these authors as manifestations of a defensive psychological attitude temporarily adopted by the patient with gross structural defects of the central nervous system as a means of immediate protection against the recognition of life-threatening disease processes.

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The author describes the behavioural and EEG modifications due to unilateral intracarotid injection of sodium Amytal in man with and without contra-lateral carotid compression.

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Though the full effects of methohexital in the cerebral circulation remain to be elucidated, existing reports suggest it is a safe provocative agent for use prior to embolotherapy for brain arteriovenous malformations.