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Anosognosia and asomatognosia during intracarotid amobarbital inactivation

From the Departments of Neurology (Drs. Meador, Loring, and Nichols) and Psychiatry (Dr. Lee), Medical College of Georgia, Augusta; and Department of Neurology (Dr. Feinberg), Beth Israel Medical Center, New York, NY.

Address correspondence and reprint requests to Dr. Kimford J. Meador, Department of Neurology, Medical College of Georgia, 1120 15th Street (BA 3410), Augusta, GA 30912.

BACKGROUND: Anosognosia (i.e., denial of hemiparesis) and asomatognosia (i.e., inability to recognize the affected limb as one’s own) occur more frequently with right cerebral lesions. However, the incidence, relative recovery, and underlying mechanisms remain unclear.

METHODS: Anosognosia and asomatognosia were examined in 62 patients undergoing the intracarotid amobarbital procedure as part of their preoperative evaluation for epilepsy surgery. Additional questions were asked in the last 32 patients studied.

RESULTS: During inactivation of the non–language-dominant cerebral hemisphere, 88% of the 62 patients were unaware of their paralysis, and 82% could not recognize their own hand at some point. Only 3% did not exhibit anosognosia or asomatognosia. In general, asomatognosia resolved earlier than anosognosia. When patients could not recognize their hand, they uniformly thought that it was someone else’s hand. Dissociations in awareness were seen in the second series of 32 patients. Although 23 patients (72%) thought that both arms were in the air, 31% pointed to the correct position of the paralyzed arm on the table. Despite the inability of 24 of 32 patients (75%) to recognize their own hand, 21% of these patients were aware that their arm was weak, and 38% had correctly located their paralyzed arm on the angiography table.

CONCLUSIONS: Anosognosia and asomatognosia are both common during acute dysfunction of the non–language-dominant cerebral hemisphere. Dissociations of perception of location, weakness, and ownership of the affected limb are frequent, as are misperceptions of location and body part identity. The dissociations suggest that multiple mechanisms are involved.

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