Anosognosia for hemiplegia with preserved awareness of complete cortical blindness following intracranial hemorrhage

A 51-year-old woman presented with anosognosia for hemiplegia (AHP), neglect, and a complete loss of vision, for which she was almost immediately aware. Neuroimaging studies revealed intracranial hemorrhages in the medial temporal lobes bilaterally, extending back to the occipital cortex, but sparin...

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Bibliographic Details
Published in:Cortex 2011-11, Vol.47 (10), p.1219-1227
Main Authors: Prigatano, George P., Matthes, Jessica, Hill, Stacy W., Wolf, Thomas R., Heiserman, Joseph E.
Format: Article
Language:English
Subjects:
Agnosia - complications
Agnosia - pathology
Agnosia - psychology
Anosognosia for hemiplegia
Anton’s syndrome
Awareness
Blindness, Cortical - complications
Blindness, Cortical - pathology
Blindness, Cortical - psychology
Cortical blindness
Dreams - psychology
Female
Hemiplegia - complications
Hemiplegia - pathology
Hemiplegia - psychology
Humans
Intracranial Hemorrhages - complications
Intracranial Hemorrhages - pathology
Magnetic Resonance Imaging
Middle Aged
Perceptual Disorders - complications
Perceptual Disorders - pathology
Perceptual Disorders - psychology
Recovery
Temporal Lobe - pathology
Tomography, X-Ray Computed
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Summary:A 51-year-old woman presented with anosognosia for hemiplegia (AHP), neglect, and a complete loss of vision, for which she was almost immediately aware. Neuroimaging studies revealed intracranial hemorrhages in the medial temporal lobes bilaterally, extending back to the occipital cortex, but sparing the calcarine cortex. A large right frontal-parietal hemorrhage which extended to the posterior body of the corpus callosum was also observed. The patient’s vision slowly improved, and by 11 months post onset, formal visual fields revealed improvement primarily in the left upper quadrants only. In contrast, resolution of her AHP occurred between the 26th and 31st day post onset. Awareness of motor impairment was correlated with her ability to initiate finger tapping in her left hemiplegic/paretic hand. During the time she was unaware of her motor deficits but aware of her visual impairments, her dreams did not reflect concerns over visual or motor limitations. The findings support a “modular” theory of anosognosia.
ISSN:0010-9452
1973-8102
DOI:10.1016/j.cortex.2010.11.013