Transient Anosognosia for Episodic Hemiparesis: A Singular Manifestation of TIAs and Epileptic Seizures
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ABSTRACT: Anosognosia is a well-known manifestation of non-dominant parietal lobe lesions and typically lasts a few days. That anosognosia may last only a few minutes to a few hours, as observed in six patients, has not been reported. In five patients, transient anosognosia for equally brief left-sided hemiparesis was a manifestation of transient ischemic attacks (TIAs). In the sixth patient, anosognosia for both a left-sided motor seizure and a subsequent brief left hemiparesis could best be explained by an epileptic ictal and post-ictal transient dysfunction of the non-dominant parietotemporal cortex. Prompt recognition of transient anosognosia, whether ischemic or epileptic, is mandatory for proper diagnosis and for rapid initiation of specific therapy.Keywords:
Anosognosia
Hemiparesis
Epileptic seizure
Transient (computer programming)
Objective: To analyze the clinical features of epilepsy following cerebral stroke seizure and its effect on the recovery of neural function.Methods: 50 patients with epilepsy following cerebral stroke seizure were analyzed in their seizure location,types,treatment time and effect.A11 cases were scored on their neural function based on the patients' conditions(slight,moderate and severe).Results: Among 980 stroke patients,50 cases developed epilepsy(5.1%,50/980).36 patients developed seizures in early stage(72%,36/50),and the others in late stage(28%,14/50).Among the 50 cases with epilepsy,36 cases suffered seizures which located in brain cortex(72%,36/50);others were located in sub-cortex(28%,14/50).In early seizure,generalized tonic-clonic seizure(GTS)occurred in 25 cases and partial seizure in 9.In late seizure,6 cases presented with generalized seizure and 10 cases with partial seizure.The scores of neural function defects(NFD)in the epilepsy group were all lower than those in the control group(P0.05).Conclusion: The epilepsy following cerebral stroke seizure usually occurred in the patients with lesions located in cerebral cortex.The epilepsy in early stage following stroke mostly presented with GTS and the one in late stage usually with partial seizure.The therapeutic efficiency of the epilepsy following cerebral stroke was worse than that of the contro1.The anti-epilepsy treatment would benefit the recovery of neural function.
Stroke
Epileptic seizure
partial seizures
Generalized epilepsy
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Anosognosia
Neurocognitive
Confabulation (neural networks)
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Objective To analyze the clinical features of epilepsy following cerebral stroke seizure and its effect on the recovery of neural function. Methods Fifty patients with epilepsy following cerebral stroke seizure were analyzed in their seizure location and type, treatment time and effect. All cases were scored on their neural function based on the patients' conditions (slight, moderate and severe). Results Among 980 stroke patients, 50 cases developed epilepsy (5.1%, 50/980). Among them, 34 patients developed seizures in early stage (72%, 36/50), others in late stage(28%,14/50). Among 50 cases with epilepsy, 36 cases suffered seizures located in brain cortex (72%, 36/50); others were located in sub-cortex (28%, 14/50). In early seizure, generalized tonic-clonic seizure (GTS) occurred in 25 cases and partial seizure in 9. In late seizure, 6 cases presented with generalized seizure and 10 cases with partial seizure. The scores of neural function defects (NFD) in the epilepsy group were all lower than those in the control group (P0.05). Conclusion The epilepsy following cerebral stroke seizure usually occurred in the patients with lesions located in cerebral cortex. The epilepsy in early stage following stroke mostly presented with GTS and the one in late stage usually with partial seizure.The theraputic efficiency of the epilepsy following cerebral stroke was worse than the effect of control. The anti-epilepsy treatment is benefit for the recovery of neural function.
Stroke
Epileptic seizure
partial seizures
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The prevalence of anosognosia after stroke is approximately 30%. Anosognosia refers to the lack of awareness of illness or specific symptom of illness in patients with neurological diseases. Because stroke patients with anosognosia are not properly comprehending the nature of their medical situation, they may not seek treatment in time, which weakens patients' commitment to treatment and rehabilitation. Anosognosia also exposes patients to dangerous situations in daily life. Anosognosia is associated with poor functional outcome after stroke, which makes the early neuropsychological identification and treatment of anosognosia important.
Anosognosia
Stroke
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Objective: To review the frequency, clinical correlates, and mechanism of anosognosia after stroke. Methods: We searched the most recent relevant literature on anosognosia after stroke and carried out a critical analysis of the main findings. Results: Anosognosia is present in about 10% of acute stroke patients and its diagnosis is relatively simple. Nevertheless, a valid and reliable standardization of diagnostic instruments and criteria for research purposes is more difficult to achieve. This limitation may partially account for various instruments available to assess anosognosia and the different strategies used to diagnose this phenomenon. Anosognosia is a fleeting phenomenon and chronic cases are infrequent. There is a robust association between anosognosia and right-hemisphere lesions involving cortical (insular, temporal, and parietal lobes) and subcortical structures (thalamus and basal ganglia). The main clinical correlates of anosognosia are the presence of neglect, cognitive deficits, previous strokes, and older age. Anosognosia has a negative impact on the rehabilitation of stroke patients. The mechanism of anosognosia remains unknown but was explained as owing to psychological denial, disconnexion between left and right hemispheres, and dysfunction of a system that monitors the intention to move and actual movements. Conclusion: Anosognosia is a relatively frequent complication of acute stroke and may become an excellent model to understand the mechanism of human awareness.
Anosognosia
Stroke
CADASIL
Denial
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In previous studies, the incidence of anosognosia for hemiparesis has varied between 17% and 58% in samples of brain damaged patients with hemiparesis.To determine whether this wide variation might be explained by the different criteria used for diagnosing anosognosia.128 acute stroke patients with hemiparesis or hemiplegia were tested for anosognosia for hemiparesis using the anosognosia scale of Bisiach et al.94% of the patients who were rated as having "mild anosognosia"-that is, they did not acknowledge their hemiparesis spontaneously following a general question about their complaints-suffered from, and mentioned, other neurological deficits such as dysarthria, ptosis, or headache. However, they immediately acknowledged their paresis when they were asked about the strength of their limbs. Their other deficits clearly had a greater impact. These patients had significantly milder paresis than those who denied their disorder even when asked directly about their limbs.Patients who do not mention their paresis spontaneously but do so when questioned about it directly should not be diagnosed having "anosognosia." If this more conservative cut off criterion is applied to the data of the present as well as previous studies, a frequency of between 10% and 18% for anosognosia for hemiparesis is obtained in unselected samples of acute hemiparetic stroke patients. The incidence thus seems smaller than previously assumed.
Anosognosia
Hemiparesis
Paresis
Dysarthria
Stroke
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Objectives – The aim of this study was to explore predictive factors of the length of hospital stay at the acute stage of right hemisphere stroke. Special attention was paid to the possible role of anosognosia for hemiparesis and anosognosia for neglect in this prediction. Patients and methods– A consecutive series of 57 patients having their first right hemisphere stroke were examined at the acute phase. Forty-nine patients were included in this study and followed-up for 12 months. The examinations were conducted within 2 weeks of onset. The outcome variable was the time (days) from stroke to discharge to home. The predictors were age, gender, size of infarct, neglect, hemiparesis, verbal memory, unawareness of illness, anosognosia for neglect, anosognosia for hemiparesis and presence of a relative at home. Results– Hemiparesis and unawareness of illness lengthened the duration of the hospital stay, the presence of a relative reduced it. Neglect was the best single predictor of poor outcome, but it had no additional value in the combination of the three predictors above. Neither anosognosia for hemiparesis nor anosognosia for neglect were important predictors. Conclusion– Hemiparesis, unawareness of illness and presence of a relative at home were the best predictors of the time from right hemisphere stroke to discharge to home.
Anosognosia
Hemiparesis
Stroke
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This review considers recent findings on classical forms of anosognosia and less dramatic disturbances in self-awareness observed in various brain disorders. It also addresses issues of clinical management and ethical treatment.The study of anosognosia for hemiplegia, Anton's syndrome, and less dramatic disturbances in self-awareness in conditions such as Alzheimer's disease, mild cognitive impairment, and severe traumatic brain injury suggests its 'multifactorial' nature. Lesions in various regions of the brain may contribute to different forms of anosognosia. Animal and human studies suggest that the insular cortex plays an important role in subjective awareness of feeling states, and may be implicated in various forms of anosognosia. Also, right frontal lobe lesions have been implicated, but typically in patients who have bilateral cerebral dysfunction. These patients require careful clinical management in light of their reduced awareness of their neurological and neuropsychological functions that impact daily activities.The study of anosognosia and disorders of self-awareness has expanded greatly over the past 20 years. Various patient groups may show different levels of impaired awareness or anosognosia. Guidelines for the clinical management and ethical treatment of these patients are needed, but beginning efforts have been made.
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Anosognosia is a neuropsychological description of unawareness or denial of
impairment. Anosognosia for memory disorder (AMD) is a common, though poorly
understood, sequelae of acquired brain injury (ABI). Many theories have sought to
characterise the neurological, cognitive and motivational bases of anosognosia for
hemiplegia, though there are few theories specific to AMD. The studies have largely
failed to identify consistent neuroanatomical correlates or types of dysfunction. This
has led to the conclusion that anosognosia is a complex multidimensional clinical
phenomenon that requires subtle elaboration.
Part of the conceptual difficulty has been a function of the relative primitiveness of
models of awareness and the tendency for different indices of anosognosia to
measure different characteristics of the disorder in an unsystematic way. Recent
candidate models of anosognosia have distinguished between deficits in metacognitive
knowledge of memory disorder and deficits in online awareness (emergent and
anticipatory) of amnesia-related errors. We examined 14 patients with ABI and 15
healthy controls using a multidimensional approach that included a structured interview
to assess the metacognitive knowledge aspects of anosognosia and several
experimental measures to assess the different aspects of impaired online awareness.
Results indicated that different patients could be classified as anosognosic according
to which measure was used and that patients could be located on a spectrum of
anosognosia which varied along axes of partiality and specifity. The results suggest
that despite anosognosia, patients can improve their awareness across learning trials
though further research is required to substantiate this. It is hoped that studies such as
this, which strive for a developmental reciprocity between theory and service-based
practice, may contribute to a more pragmatic understanding of AMD in patients with
ABI.
Anosognosia
Acquired brain injury
Denial
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Background and Purpose: In previous studies, the incidence of anosognosia for hemiparesis varied between 17% and 58% in samples of brain damaged patients with hemiparesis. One explanation for this wide variation might be different criteria used for the diagnosis of anosognosia.
Anosognosia
Hemiparesis
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