Laboratório de Estudos de Linguagem, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, CHULN, Lisbon, Portugal.
Eur J Neurol. 2023 Jan;30(1):125-133. doi: 10.1111/ene.15557. Epub 2022 Sep 29.
Incongruent beliefs about self-localization in space markedly disturb patients' behavior. Spatial delusions, or reduplicative paramnesias, are characterized by a firm conviction of place reduplication, transformation, or mislocation. Evidence suggests they are frequent after right hemisphere lesions, but comprehensive information about their clinical features is lacking.
We prospectively screened 504 acute right-hemisphere stroke patients for the presence of spatial delusions. Their behavioral and clinical features were systematically assessed. Then, we analyzed the correlation of their duration with the magnitude of structural disruption of belief-associated functional networks. Finally, we described the syndrome subtypes and evaluated whether the clinical categorization would be predicted by the structural disruption of familiarity-associated functional networks using an unsupervised k-means clustering algorithm.
Sixty patients with spatial delusions were identified and fully characterized. Most (93%) localized the misidentified places closer to home than the hospital. The median time duration was 3 days (interquartile range = 1-7 days), and it was moderately correlated with the magnitude of structural-functional decoupling of belief-associated functional networks (r = 0.39, p = 0.02; beta coefficient regressing for lesion volume = 3.18, p = 0.04). Each clinical subtype had characteristic response patterns, which were reported, and representative examples were provided. Clustering based on structural disruption of familiarity- and unfamiliarity-associated functional networks poorly matched the clinical categorization (lesion: Rand index = 0.47; structural disconnection: Rand index = 0.51).
The systematic characterization of the peculiar clinical features of stroke-associated spatial delusions may improve the syndrome diagnosis and clinical approaches. The novel evidence about their neural correlates fosters the clarification of the pathophysiology of delusional misidentifications.
对自我定位的不一致信念会显著扰乱患者的行为。空间妄想，或重复妄想，其特征是对地点重复、转变或错位的坚定信念。有证据表明它们在右脑损伤后很常见，但缺乏对其临床特征的全面了解。
我们前瞻性地筛查了 504 例急性右脑卒中患者是否存在空间妄想。系统评估了他们的行为和临床特征。然后，我们分析了其持续时间与信念相关功能网络结构破坏程度的相关性。最后，我们描述了综合征亚型，并使用无监督 k-均值聚类算法评估了临床分类是否可以通过熟悉度相关功能网络的结构破坏来预测。
确定并充分描述了 60 例有空间妄想的患者。大多数（93%）将错误识别的地点定位在家附近，而不是医院附近。中位时间持续时间为 3 天（四分位间距 1-7 天），与信念相关功能网络结构功能分离程度中度相关（r=0.39，p=0.02；病变体积回归β系数=3.18，p=0.04）。每种临床亚型都有特征性的反应模式，并进行了报告，提供了代表性的例子。基于熟悉度和不熟悉度相关功能网络结构破坏的聚类与临床分类不匹配（病变：兰德指数=0.47；结构不连续：兰德指数=0.51）。
对与中风相关的空间妄想的特殊临床特征进行系统描述可能会改善综合征诊断和临床方法。对其神经相关因素的新证据有助于阐明妄想性识别错误的病理生理学。
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