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非局灶性忽视和自我中心性忽视的预后:来自临床扫描的证据。

The prognosis of allocentric and egocentric neglect: evidence from clinical scans.

机构信息

Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.

出版信息

PLoS One. 2012;7(11):e47821. doi: 10.1371/journal.pone.0047821. Epub 2012 Nov 1.


DOI:10.1371/journal.pone.0047821
PMID:23133604
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3486857/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/1a28570522b8/pone.0047821.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/079bf5a45df6/pone.0047821.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/03f9748c0e48/pone.0047821.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/c49a560fd6b8/pone.0047821.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/b79184b1a09b/pone.0047821.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/1a28570522b8/pone.0047821.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/079bf5a45df6/pone.0047821.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/03f9748c0e48/pone.0047821.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/c49a560fd6b8/pone.0047821.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/b79184b1a09b/pone.0047821.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7a5c/3486857/1a28570522b8/pone.0047821.g005.jpg

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引用本文的文献

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Novel Insights into Viewer-Centered Versus Stimulus-Centered Hemispatial Neglect: A Cross-Sectional Behavioral and Imaging Study of Acute Stroke.

Brain Sci. 2025-2-17

[2]
Predicting individual long-term prognosis of spatial neglect based on acute stroke patient data.

Brain Commun. 2025-1-31

[3]
Comprehensive voxel-wise, tract-based, and network lesion mapping reveals unique architectures of right and left visuospatial neglect.

Brain Struct Funct. 2023-12

[4]
Spatial cognition training rapidly induces cortical plasticity in blind navigation: Transfer of training effect & Granger causal connectivity analysis.

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[5]
Gaze-contingent display technology can help to reduce the ipsilesional attention bias in hemispatial neglect following stroke.

J Neuroeng Rehabil. 2022-11-16

[6]
Multipurpose Spatiomotor Capture System for Haptic and Visual Training and Testing in the Blind and Sighted.

IS&T Int Symp Electron Imaging. 2021

[7]
Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke.

Neurorehabil Neural Repair. 2021-9

[8]
Applications of Functional Magnetic Resonance Imaging in Determining the Pathophysiological Mechanisms and Rehabilitation of Spatial Neglect.

Front Neurol. 2020-11-12

[9]
Exploratory examination of lexical and neuroanatomic correlates of neglect dyslexia.

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[10]
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本文引用的文献

[1]
Neuroanatomical Dissections of Unilateral Visual Neglect Symptoms: ALE Meta-Analysis of Lesion-Symptom Mapping.

Front Hum Neurosci. 2012-8-10

[2]
Systematic assessment of apraxia and functional predictions from the Birmingham Cognitive Screen.

J Neurol Neurosurg Psychiatry. 2012-3-1

[3]
'The anatomy underlying acute versus chronic spatial neglect' also depends on clinical tests.

Brain. 2012-2

[4]
An anatomical account of somatoparaphrenia.

Cortex. 2011-6-22

[5]
The anatomy of spatial neglect.

Neuropsychologia. 2011-7-2

[6]
Separating forms of neglect using the Apples Test: validation and functional prediction in chronic and acute stroke.

Neuropsychology. 2011-9

[7]
Reperfusion of specific cortical areas is associated with improvement in distinct forms of hemispatial neglect.

Cortex. 2011-1-22

[8]
The anatomy underlying acute versus chronic spatial neglect: a longitudinal study.

Brain. 2010-12-13

[9]
Separating neural correlates of allocentric and egocentric neglect: distinct cortical sites and common white matter disconnections.

Cogn Neuropsychol. 2010-5

[10]
The neural mechanisms of visual selection: the view from neuropsychology.

Ann N Y Acad Sci. 2010-3

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