Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity

OBJECTIVE: The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS: This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors. RESULTS: We studied 60 patients with a median age of 68 (34-89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03-1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13-2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78-0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48-0.92], p=0.017). CONCLUSION: The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.

Standardization of the face-hand test in a Brazilian multicultural population: prevalence of sensory extinction and implications for neurological diagnosis

OBJECTIVE: The face-hand test is a simple, practical, and rapid test to detect neurological syndromes. However, it has not previously been assessed in a Brazilian sample; therefore, the objective of the present study was to standardize the face-hand test for use in the multi-cultural population of Brazil and identify the sociodemographic factors affecting the results. METHODS: This was a cross sectional study of 150 individuals. The sociodemographic variables that were collected included age, gender, race, body mass index and years of education. Standardization of the face-hand test occurred in 2 rounds of 10 sensory stimuli, with the participant seated to support the trunk and their vision obstructed in a sound-controlled environment. The face-hand test was conducted by applying 2 rounds of 10 sensory stimuli that were applied to the face and hand simultaneously. The associations between the face-hand test and sociodemographic variables were analyzed using Mann-Whitney tests and Spearman correlations. Binomial models were adjusted for the number of face-hand test variations, and ROC curves evaluated sensitivity and specificity of sensory extinction. RESULTS: There was no significant relationship between the sociodemographic variables and the number of stimuli perceived for the face-hand test. There was a high relative frequency of detection, 8 out of 10 stimuli, in this population. Sensory extinction was 25.3%, which increased with increasing age (OR=1.4[1:01–1:07]; p=0.006) and decreased significantly with increasing education (OR=0.82[0.71-0.94]; p=0.005). CONCLUSION: In the Brazilian population, a normal face-hand test score ranges between 8–10 stimuli, and the results indicate that sensory extinction is associated with increased age and lower levels of education.

Aspectos clínicos y modelos teóricos en el Síndrome de Neglect / Clinicalaspects and theoretical models in Neglect Syndrome

En este trabajo se revisa y discute el síndrome de neglect considerando diferentes modelos teóricos explicativos; de dirección atencional, de asimetrías hemisféricas cerebrales, del sesgo atencional o el modelo de atención selectiva. Se consideran los aspectos cognitivos, emocionales y neuroconductuales. El Síndrome de Neglect generalmente es consecuencia de un accidente cerebrovascular, afecta al hemisferio cerebral derecho y señala directamente al lóbulo parietal. Este es el resultado de una definición anatómica vasta más que una unidad fisiológica o funcional. El síndrome se manifiesta por déficits en la atención perceptiva y en la respuesta a estímulos presentados en el hemicampo contralesional. Es un síndrome heterogéneo. Pese a la preponderancia de las teorías de déficits atencionales, las explicaciones de déficits perceptivos y de representación del espacio están presentes. Son variaciones del síndrome la heminatención, la extinción, la hemicinesia y el neglect hemiespacial. Se resalta la importancia de incluir los aspectos emocionales y neuroconductuales junto con los cognitivos y la rehabilitación motora en el proceso de rehabilitación neuropsicológica del síndrome. Son característicos los síntomas de anosognosia, extinción, desinhibición de conducta, conducta de utilización o la falta de afecto. En cuanto a la recuperación y a cómo ocurre esta, se discuten varias explicaciones alternativas y se apunta el papel de la motivación como factor importante en el éxito de los tratamientos.

This paper reviews the syndrome Neglect considering different theoretical models: attentional direction; of cerebral hemispheric asymmetry, attentional bias, selective attention model. The cognitive, emotional and neurobehavioral characteristics are high lighted. Neglect syndrome usually results from a stroke that affects the right cerebral hemisphere and points directly to the parietal lobe. This is the result of an extensive anatomical definition more than that one functional unit or physiological. The syndrome is manifested by deficits in attention and perceptual responses to stimuli presented in the contralesional hemispace. Neglect is a heterogeneous syndrome. Despite the preponderance of theories of the attentional deficit, explanations of perceptual deficits and representation of space are present. The syndrome manifestations are the heminatención, the extinction, the hemispatial hemicinesia and the neglect. They are very important the emotional aspects as the cognitive, neurobehavioral and motor rehabilitation, in the neuropsychological rehabilitation process of syndrome. Symptoms of anosognosia, extinction, behavioral disinhibition, and the utilization behavior or lack of affection are the most prominent in the syndrome. In terms of recovery, how to happen this? We discuss several alternative explanations and the role of motivation as an important factor in the success of treatments.

¿Qué es la anosognosia?: un reto transdisciplinario: [revisión] / What is anosognosia?: a transdisciplinary challenge: [review]

¿Qué es la Anosognosia? Esta se puede definir como un desorden neuropsicológico el cual lleva al paciente a desconocer un déficit que sufre, debido a una lesión cerebral. Sin embargo, resulta problemático definir dicho fenómeno, pues hay conceptos como negación, confabulación y negligencia, que pueden en parte explicarla, pero ¿Son estos necesarios y/o suficientes para definir el fenómeno? Al parecer, con base en toda la información clínica, hay que trabajar en una clarificación conceptual pendiente. Este artículo parte de la pregunta inicial como problema central y pretende contribuir a dicha clarificación. Para realizar lo anterior se divide el trabajo en tres partes: Primero, se hará un análisis del concepto central, Segundo, se considerarán de forma general las posibles respuestas a la pregunta desde dos marcos conceptuales y desde el psicoanálisis, Tercero y último, para concluir se realizará una síntesis de los principales puntos discutidos.

What is Anosognosia? This can be defined as a neuropsychological disorder which produces in the patient an unawareness of a deficit from which he suffers, caused by a cerebral injury. Nonetheless, the definition of the phenomenon is a problematic issue, because there are some concepts as denial, confabulation and neglect, on terms of which a definition can be build up, but ¿Are these concepts necessary and/or sufficient to define the phenomenon? It seems that, taking into account the clinical information, the definition of the main concept is an issue worth while (necessary!) working on. To address the problematic issue, this paper is divided into three parts: The first will focus on the analysis of the main concept, the second will considerate the possible general answers to the main question from two conceptual frameworks and also from psychoanalysis, and the third and last, will offer a conclusion taking into account the main points of the discussion.

Un caso de agnosia visual aperceptiva de tipo integrativa / A case of apperceptive visual agnosia showing an integrative disorder

Presentamos un paciente (C.A.) de 38 años afectado de alteraciones en el reconocimiento visual secundarias a una lesión isquémica cerebral posterior bilateral (RNM). En el examen neuropsicológico encontramos dificultades en reconocer visualmente rostros, objetos y figuras de objetos, a pesar de que los puede ver, dibujar y describir. El reconocimiento táctil y auditivo fue normal. Nuestro paciente tiene una prosopoagnosia, una agnosia visual de objetos, una simultagnosia, una agnosia topográfica y una amnesia episódica global. El defecto en el reconocimiento de objetos y de rostros no responde sólo a un trastorno perceptivo (representación formal). El conocimiento semántico de objetos y rostros es correcto pues puede evocar verbalmente la imagen eidética de aquellos que no puede reconocer (representación semántica). El paciente falla en el estadio de integración jerarquización de las partes necesarias para el correcto apareamaiento entre la imagen visual que ingresa con la imagen eidética del conocimiento semántico correspondiendo a una agnosia visual de tipo integrativa

Unilateral neglect syndrome: clinical and topographic study of 20 subjects

Foram estudados 20 pacientes com a síndrome da negligência unilateral (SNU), de idades variáveis entre 29 e 76 anos, sendo 10 do sexo masculino e 10 do sexo feminino, todos submetidos à tomografia axial computadorizada do crânio. Baseados nesta casuística, concluimos: o fenômeno de extinçäo foi manifestaçäo constante da SNU; a prova da secçäo de traços foi a que se revelou mais eficaz na identificaçäo da negligência visual; o lobo parietal direito foi a regiäo anatômica mais freqüentemente comprometida na SNU