Abstract
We studied clinical features and various background factors of anosognosia (Babinski, 1914) and somatoparaphrenia (Gerstmann, 1942) resulting from cerebrovascular disease. Subjects in this study were 21 patients (11 males and 10 females ; range of age, 50 - 86 years; 19 right-sided and 2 left-sided lesions ; all right-handed ) exhibiting anosognosia and/or somatoparaphrenia, who were selected from 556 consecutive admissions to our hospitals for treatment of acute stroke between April 1991 and July 1994. They comprised 8 cases with anosognosia without somatoparaphrenia, 12 cases with anosognosia and somatoparaphrenia, and 1 case with somatoparaphrenia and hemiasomatognosia. Regarding lesion location detected by cranial CT or MRI, patients with anosognosia had a highly frequency of large right hemisphere lesions, primarily involving parietal lobe and/or thalamus, and particularly anosognosia with somatoparaphrenia was related to more widespread lesions. In left hemisphere stroke patients with slight aphasia, these symptoms were associated with lesions including thalamus, basal ganglia and posterior subcortical areas. Anosognosia was seen almost similarly in the affected upper and lower limbs, while somatoparaphrenia was usually seen in the affected upper limb or forearm alone. In particular anosognosia with somatoparaphrenia was mostly seen in older female with brain atrophy. It was frequently accompanied by severe contralateral hemiplegia, deep sensory deficit, homonymous hemianopsia, unilateral spatial neglect and disinhibition, and likely to last for long time. These findings mean poor functional prognosis.
