Department of Rehabilitation Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA,
Neurocenter, Swiss Medical Network, Clinique Valmont, Montreux, Switzerland.
Eur Neurol. 2020;83(4):438-446. doi: 10.1159/000510397. Epub 2020 Sep 14.
Anosognosia and hemineglect are among the most startling neurological phenomena identified during the 20th century. Though both are associated with right hemisphere cerebral dysfunction, notably stroke, each disorder had its own distinct literature. Anosognosia, as coined by Babinski in 1914, describes patients who seem to have no idea of their paralysis, despite general cognitive preservation. Certain patients seem more than unaware, with apparent resistance to awareness. More extreme, and qualitatively distinct, is denial of hemiplegia. Various interpretations of pathogenesis are still deliberated. As accounts of its captivating manifestations grew, anosognosia was established as a prominent symbol of neurological and psychic disturbance accompanying (right-hemisphere) stroke. Although reports of specific neglect-related symptomatology appeared earlier, not until nearly 2 decades after anosognosia's inaugural definition was neglect formally defined by Brain, paving a path spanning some years, to depict a class of disorder with heterogeneous variants. Disordered awareness of body and extrapersonal space with right parietal lesions, and other symptom variations, were gathered under the canopy of neglect. Viewed as a disorder of corporeal awareness, explanatory interpretations involve mechanisms of extinction and perceptual processing, disturbance of spatial attention, and others. Odd alterations involving apparent concern, attitudes, or belief characterize many right hemisphere conditions. Anosognosia and neglect are re-examined, from the perspective of unawareness, the nature of belief, and its baffling distortions. Conceptual parallels between these 2 distinct disorders emerge, as the major role of the right hemisphere in mental representation of self is highlighted by its most fascinating syndromes of altered awareness.
病感失认症和半侧忽略是 20 世纪发现的最令人震惊的神经现象之一。尽管两者都与右脑大脑功能障碍有关，特别是中风，但每种疾病都有其独特的文献。病感失认症是由 Babinski 于 1914 年创造的，描述的是尽管认知能力普遍保留，但患者似乎对自己的瘫痪一无所知。某些患者似乎不仅没有意识到，而且明显抗拒意识到。更极端的是，否认偏瘫。对发病机制的各种解释仍在审议中。随着对其迷人表现的描述不断增加，病感失认症成为伴随（右脑）中风的神经和心理障碍的突出象征。尽管与特定忽视相关的症状更早出现，但直到病感失认症首次定义 20 年后，忽视才由 Brain 正式定义，为描绘具有异质变体的一类疾病开辟了一条跨越数年的道路。右顶叶病变导致身体和体外空间感知障碍以及其他症状变化，这些都被归入忽视的范畴。从无意识、信念的本质以及令人困惑的扭曲的角度来看，将其视为一种身体意识障碍，解释性解释涉及消除和感知处理机制、空间注意力障碍等。许多右脑疾病都有明显的异常改变，涉及到明显的关注、态度或信念。病感失认症和忽视症从无意识、信念的本质以及令人困惑的扭曲的角度进行了重新审视。由于右脑在自我心理表象中的主要作用，这两种截然不同的疾病之间出现了概念上的相似之处，其最引人入胜的改变意识的综合征突显了这一点。
