The University of Western Australia, Perth, Australia.
Can J Psychiatry. 2010 Jun;55(6):355-61. doi: 10.1177/070674371005500604.
To review the frequency, clinical correlates, and mechanism of anosognosia after stroke.
We searched the most recent relevant literature on anosognosia after stroke and carried out a critical analysis of the main findings.
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, disconnection between left and right hemispheres, and dysfunction of a system that monitors the intention to move and actual movements.
Anosognosia is a relatively frequent complication of acute stroke and may become an excellent model to understand the mechanism of human awareness.
综述脑卒中后失认症的频率、临床相关性及发病机制。
我们检索了脑卒中后失认症的最新相关文献，并对主要研究结果进行了批判性分析。
约 10%的急性脑卒中患者存在失认症，其诊断相对简单。然而，为研究目的制定有效且可靠的诊断工具和标准更为困难。这种局限性可能部分解释了评估失认症的各种工具以及诊断该现象的不同策略。失认症是一种短暂的现象，慢性病例较为少见。失认症与右半球病变密切相关，病变部位涉及皮质（岛叶、颞叶和顶叶）和皮质下结构（丘脑和基底节）。失认症的主要临床相关性是存在忽视、认知缺陷、既往脑卒中发作和年龄较大。失认症对脑卒中患者的康复有负面影响。失认症的发病机制尚不清楚，但可解释为心理否认、左右半球之间的脱节以及监测意向运动和实际运动的系统功能障碍。
失认症是急性脑卒中的一种相对常见的并发症，可能成为理解人类意识机制的一个极好模型。
