Jang Sung Ho, Jang Woo Hyuk
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyung-dong, Nam-ku, Daegu Department of Occupational Therapy, College of Health Science, Kangwon National University, Hwangjo-gil, Dogye-eup, Samcheok-si, Gangwon-do, Republic of Korea.
Medicine (Baltimore). 2018 Sep;97(37):e12394. doi: 10.1097/MD.0000000000012394.
Egocentric neglect is characterized by responses missing on the contralateral side with respect to the viewer, while allocentric neglect is characterized in responses missing on the contralateral side with respect to the object . However, little has been reported about the neural tracts associated with egocentric and allocentric neglect. We investigated which neural tracts were involved in two types of neglect (egocentric and allocentric) in a stroke patient who showed allocentric neglect by using the Apple Cancellation test, a specialized test to distinguish between egocentric and allocentric neglect.
He showed good cognitive function but presented with severe neglect on the left side (A 42-year-old, right-handed male patient). He was unable to undergo even the pencil and paper test for evaluation of the severity of neglect.
He was diagnosed as spontaneous intracerebral hemorrhage at the right basal ganglia and underwent conservative management at the neurosurgery department of a university hospital.
Two weeks after onset, he began rehabilitation at the rehabilitation department of the same university hospital. During a seven month rehabilitation, the patient showed significant improvement of his severe left neglect.
We used the Apple Cancellation test to distinguish between egocentric and allocentric neglect; the results failed to reveal egocentric neglect, however, they did reveal severe allocentric neglect. In addition, on diffusion tensor tractography (DTT) at 2 weeks after onset, the right superior longitudinal fasciculus (SLF) showed partial injury and narrowing in the parietal lobe compared to that of the left SLF. In addition, the right inferior fronto-occipital fasciculus (IFOF) was not reconstructed. By contrast, on 7-month post-onset DTT, the right SLF revealed elongation and thickening in the parietal lobe that approached similarity to that for the left SLF. However, the right IFOF was still not reconstructed.
The associations of egocentric neglect with the dorsal pathway (SLF) and the association of allocentric neglect with the ventral pathway (IFOF) in the right hemisphere were demonstrated in a stroke patient. It appears that DTT can be helpful in demonstrating both the affected pathway and the neglect type in patients with neglect.
自我中心性忽视的特征是相对于观察者而言对侧的反应缺失，而空间中心性忽视的特征是相对于物体而言对侧的反应缺失。然而，关于与自我中心性和空间中心性忽视相关的神经束的报道较少。我们通过使用苹果删除测试（一种区分自我中心性和空间中心性忽视的专门测试），对一名表现出空间中心性忽视的中风患者进行研究，以探究哪些神经束参与了两种类型的忽视（自我中心性和空间中心性）。
他认知功能良好，但左侧存在严重忽视（一名42岁右利手男性患者）。他甚至无法进行纸笔测试来评估忽视的严重程度。
他被诊断为右侧基底节区自发性脑出血，并在一家大学医院的神经外科接受了保守治疗。
发病两周后，他开始在同一大学医院的康复科进行康复治疗。在七个月的康复过程中，患者严重的左侧忽视有了显著改善。
我们使用苹果删除测试来区分自我中心性和空间中心性忽视；结果未显示自我中心性忽视，但确实显示出严重的空间中心性忽视。此外，在发病后两周的弥散张量纤维束成像（DTT）中，与左侧上纵束相比，右侧上纵束在顶叶显示出部分损伤和变窄。此外，右侧额枕下束（IFOF）未重建。相比之下，在发病后七个月的DTT中，右侧上纵束在顶叶显示出伸长和增厚，接近与左侧上纵束相似。然而，右侧额枕下束仍然未重建。
在一名中风患者中证实了右半球自我中心性忽视与背侧通路（上纵束）以及空间中心性忽视与腹侧通路（额枕下束）之间的关联。看来DTT有助于在忽视患者中显示受影响的通路和忽视类型。
