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On-line anosognosia

Unawareness for chorea in real time but not on videotape delay

From the Department of Neurology (Drs. Shenker, Wylie, Fuchs, and Manning), University of Virginia, Charlottesville; and Department of Neurology (Dr. Heilman), University of Florida and Malcom Randal Veteran’s Administration Medical Center, Gainesville.

Address correspondence and reprint requests to Dr. Shenker, P.O. Box 800394, Department of Neurology, University of Virginia, Charlottesville, VA 22908-0394; e-mail: jis2p{at}virginia.edu

In hemiplegics, anosognosia (unawareness of deficit) rests on a mismatch between expected and actual movement: a feedback hypothesis emphasizes sensory deficits or neglect, a feedforward hypothesis postulates impaired intention to move. Anosognosia for other problems is less studied. The authors report a man without sensory deficits who was unaware of choreiform movements, except on videotape delay. The authors believe that a feed-forward mechanism underlies his "on-line" unawareness.

Received August 7, 2003. Accepted in final form March 1, 2004.