Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
PLoS One. 2012;7(11):e47821. doi: 10.1371/journal.pone.0047821. Epub 2012 Nov 1.
We contrasted the neuroanatomical substrates of sub-acute and chronic visuospatial deficits associated with different aspects of unilateral neglect using computed tomography scans acquired as part of routine clinical diagnosis. Voxel-wise statistical analyses were conducted on a group of 160 stroke patients scanned at a sub-acute stage. Lesion-deficit relationships were assessed across the whole brain, separately for grey and white matter. We assessed lesions that were associated with behavioural performance (i) at a sub-acute stage (within 3 months of the stroke) and (ii) at a chronic stage (after 9 months post stroke). Allocentric and egocentric neglect symptoms at the sub-acute stage were associated with lesions to dissociated regions within the frontal lobe, amongst other regions. However the frontal lesions were not associated with neglect at the chronic stage. On the other hand, lesions in the angular gyrus were associated with persistent allocentric neglect. In contrast, lesions within the superior temporal gyrus extending into the supramarginal gyrus, as well as lesions within the basal ganglia and insula, were associated with persistent egocentric neglect. Damage within the temporo-parietal junction was associated with both types of neglect at the sub-acute stage and 9 months later. Furthermore, white matter disconnections resulting from damage along the superior longitudinal fasciculus were associated with both types of neglect and critically related to both sub-acute and chronic deficits. Finally, there was a significant difference in the lesion volume between patients who recovered from neglect and patients with chronic deficits. The findings presented provide evidence that (i) the lesion location and lesion size can be used to successfully predict the outcome of neglect based on clinical CT scans, (ii) lesion location alone can serve as a critical predictor for persistent neglect symptoms, (iii) wide spread lesions are associated with neglect symptoms at the sub-acute stage but only some of these are critical for predicting whether neglect will become a chronic disorder and (iv) the severity of behavioural symptoms can be a useful predictor of recovery in the absence of neuroimaging findings on clinical scans. We discuss the implications for understanding the symptoms of the neglect syndrome, the recovery of function and the use of clinical scans to predict outcome.
我们使用计算机断层扫描 (CT) 扫描来对比与单侧忽略不同方面相关的亚急性和慢性视觉空间缺陷的神经解剖学基础,这些扫描是作为常规临床诊断的一部分获取的。对一组在亚急性期扫描的 160 名中风患者进行了体素统计分析。在全脑范围内评估了灰质和白质的病变-缺陷关系。我们评估了与行为表现相关的病变:(i)在亚急性期(中风后 3 个月内)和(ii)在慢性期(中风后 9 个月)。亚急性期的向心和自我忽视症状与额叶内分离区域以及其他区域的病变有关。然而,额叶病变与慢性期的忽视无关。另一方面,角回的病变与持续性向心性忽视有关。相比之下,延伸至缘上回的颞上回内的病变以及基底节和岛叶内的病变与持续性自我忽视有关。颞顶联合区的损伤与亚急性期和 9 个月后两种类型的忽视有关。此外,由于沿胼胝体上束损伤导致的白质连接中断与两种类型的忽视有关,并且与亚急性和慢性缺陷都密切相关。最后,在忽视恢复的患者和有慢性缺陷的患者之间,病变体积存在显著差异。研究结果表明:(i)可以使用临床 CT 扫描成功预测忽视的结果,基于病变位置和病变大小;(ii)病变位置本身可以作为持续性忽视症状的关键预测因素;(iii)广泛的病变与亚急性期的忽视症状有关,但只有其中一些是预测忽视是否会成为慢性疾病的关键;(iv)在缺乏临床扫描神经影像学发现的情况下,行为症状的严重程度可以作为恢复的有用预测指标。我们讨论了理解忽视综合征症状、功能恢复以及使用临床扫描预测结果的意义。
Arch Phys Med Rehabil. 2012-1
Front Hum Neurosci. 2012-8-10
IS&T Int Symp Electron Imaging. 2023-1
IS&T Int Symp Electron Imaging. 2021
Neurorehabil Neural Repair. 2021-9
Neuropsychology. 2020-1-30
Front Hum Neurosci. 2012-8-10
J Neurol Neurosurg Psychiatry. 2012-3-1
Cortex. 2011-6-22
Neuropsychologia. 2011-7-2
Ann N Y Acad Sci. 2010-3