Cambier J, Signoret J L, Bolgert F
Clinique Neurologique, Hôpital Beaujon, Paris.
Rev Neurol (Paris). 1989;145(8-9):640-5.
Visual agnosia for objects is a difficulty in recognizing objects presented visually. This difficulty can not be explained by a mental deterioration, a disorder of attention or a lack of familiarity with the object. Two criteria are essential but disputed: the absence of visual sensory difficulty necessary for adequate perception; possible recognition of the object by another sensory modality. An object is characterized by a triple representation: formal, semantic, lexical. The clinical, cognitive, pathophysiological analysis lead to distinguish 3 types of visual agnosia. 1) Aperceptive visual agnosia: patients see badly with morphological errors; the disorder concerns visual informations processing that is a necessary condition for identifying the formal representation of the object; the lesions are bilateral and involve the occipito-temporal cortex. 2) Associative visual agnosia: patients can copy, are not aphasic, but give erroneous verbal responses; the disorder concerns the links between formal representations and semantic, lexical representations; the lesions are unilateral and involve the left gyrus angularis connections. 3) Asemantic visual agnosia: patients have lost the meanings of objects and words; the disorder concerns semantic representations; the lesions are bilateral and involve the temporo-limbic cortex.
物体视觉失认是指在视觉上呈现物体时难以识别。这种困难无法用智力衰退、注意力障碍或对物体不熟悉来解释。有两个标准至关重要但存在争议:缺乏足够感知所需的视觉感觉困难;物体可能通过另一种感觉模态被识别。一个物体具有三重表征:形式、语义、词汇。临床、认知、病理生理分析导致区分出3种视觉失认类型。1)知觉性视觉失认:患者视力差且存在形态错误;该障碍涉及视觉信息处理,这是识别物体形式表征的必要条件;病变是双侧的,累及枕颞叶皮质。2)联想性视觉失认:患者能够临摹,无失语症,但给出错误的言语反应;该障碍涉及形式表征与语义、词汇表征之间的联系;病变是单侧的,累及左侧角回连接。3)语义性视觉失认:患者失去了物体和单词的意义;该障碍涉及语义表征;病变是双侧的,累及颞叶边缘皮质。