Agnosia
Introduction
Introduction to agnosia Agnosia refers to the inability to understand the clinical symptoms of the body parts and familiar objects through organs without sensory insufficiency, mental decline, unconsciousness, and inattention. Lack of cognitive ability including sight, hearing, touch and body parts. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Cause of aphasia
The occipital lobe is the visual cortical center, which is mainly related to visual acuity and visual memory. The lesions in the 18th and 19th districts cause visual agnosia. The dominant hemisphere temporal lobe auditory area is related to functions such as speech comprehension and auditory analysis. Hearing aphasia occurs when the injury occurs. The parietal lobe is the cortical area responsible for understanding the activity, and is the cortical area based on the concept of behavior. Tactile aphasia and body image loss occur in the injury. In the case of superior hemisphere parietal lobe lesions, both loss of writing, miscalculation, left and right resolution disorders, and finger ignorance can occur at the same time. It is clinically known as Gerstmann syndrome.
Agnosia is mainly manifested in four aspects: visual, auditory, tactile and physical (body image). Clinically, it is called aphasia. Brain damage caused by various causes can lead to aphasia. Clinically, agnosia More common in patients with cerebrovascular disease, but clinicians often ignore and can not be diagnosed, can also be seen in brain tumors, brain trauma and brain stereotactic destruction of patients after surgery.
Cortical lesions at the top-occipital junction of the right hemisphere can mainly lead to visual space agnosia; face agnosia is most common in the right central posterior gyrus; color cognitive impairment is more common in the left iliac-occipital lesion; The main role of cognition and processing.
Critchley's anatomical parts of body image damage are summarized as:
(1) Extensive brain damage.
(2) The right parietal lobe without special areas.
(3) Right thalamus.
(4) The right thalamus-parietal lobe, especially the superior fiber.
(5) The right parietal lobe and thalamus are simultaneously damaged.
(6) Steroidal fibers.
Some researchers also emphasized the body image disorder caused by left hemisphere damage, mainly in the left occipital occipital lobe, especially the subcortical cortex and its associated white matter, subcortical basal ganglia and thalamus, which appeared in multiple sclerosis. Body image disorder, an autopsy found that the brain, brain stem, cerebellum and spinal cord have lesions.
Gerstmann believes that vision, touch, proprioception (including vestibule) and other sensations (such as visceral sensation) play an important organizational preparation in the integration of body image formation, and that body image disorder is due to sensory acceptance and spirit. The connection between the images was interrupted, and the result of the integration chain was compromised. Gerstmann believed that the patients psychology, pre-existing personality, emotional performance and past experience were related to the onset, and pointed out that the left hemisphere was damaged and the symptoms were bilateral. It undermines the concept - symbolic function, the real body image disorder occurs, and the right hemisphere damages its symptoms only on one side, due to the perception - cognitive function is impaired, he emphasizes that the finger agnosia has a primary concept - The meaning of symbolic disorder, because the understanding of the finger is the most differentiated and most vulnerable to the function, Gerstmann syndrome is common in the dominant hemisphere parietal hornback lesion.
Prevention
Aphasia prevention
Early detection, early treatment.
Complication
Aphasia complications Complication
Spatial perception barriers, hallucinations.
Symptom
Asymmetry Symptoms Common Symptoms Sensory Disorders Blindness Spatial Perception Disorders Illusion Visual Agnosia Smart Reduced Fatigue Spinal Cord Disease
1. Tactile agnosia:
Mainly for the lack of physical feeling, the basic feelings of the patient's touch, temperature, and proprioception exist, but after closing the eyes, the object cannot be identified by touch.
2. Visual agnosia:
Including object agnosia, appearance agnosia, simultaneous agnosia, color agnosia, visual spatial agnosia and so on.
(1) Object agnosia: The patient cannot recognize the common items that are clearly seen, such as hats, gloves, pens, etc.
(2) Appearance agnosia: The patient does not know the appearance of familiar people (including the closest people such as wives and children).
(3) Simultaneous agnosia: also known as comprehensive agnosia. The patient can understand all parts of the matter, but cannot understand the whole picture of things. For example, if two people perform baseball practice on one painting, they can't identify the two people who vote for the ball.
(4) Color misrecognition: The name and difference of the color cannot be recognized.
(5) Visual space agnosia: The spatial position of the object and the spatial relationship between the objects cannot be recognized.
3. Auditory agnosia:
Can hear a variety of sounds, but can not recognize the type of sound. If you close your eyes, you will not be able to recognize familiar bells, animal screams, etc.
4. Body image loss syndrome:
Including pathological agnosia, self-perception, and Gerst-mann syndrome.
(1) Asymptomatic aphasia: also known as Anoton-Babinskin syndrome. The patient lacks self-knowledge about his condition and denies the fact of physical illness. For example, denying the existence of blindness and blindness.
(2) Self-perceived aphasia: The typical manifestation is to deny the presence of half of the body on the opposite side of the lesion. When others show him his contralateral upper limbs, he will deny that he belongs to himself.
(3) Gerstmann syndrome: also known as bilateral physical agnosia. The patient has finger agnosia, left-right directional agnosia, miscalculation, and aphasia. However, the above symptoms may not all occur, and there may be color agnosia and visual agnosia.
Examine
Agnosia check
Laboratory inspection
1. Blood routine, blood biochemistry, electrolytes: pay attention to the specific changes in the diagnostic value of the primary disease.
2. Blood sugar, immune items, cerebrospinal fluid examination, if abnormal, there is a differential diagnosis.
The following items are abnormal and have differential diagnosis significance.
Film degree exam
1. Brain CT, MRI examination.
2. EEG, fundus examination.
Agnostic assessment
Indications
Agnostic assessment is applicable to cerebrovascular accident, brain trauma, hypoxic brain damage, cerebral palsy, toxic encephalopathy, and senile degenerative encephalopathy. Brain injury caused by visual spatial disturbance, unilateral neglect, disease loss, Gerstmam Syndrome, etc.
Contraindication
1. Poor systemic condition, advanced disease or poor physical strength is difficult to tolerate the examiner.
2. Loss of consciousness or obstacles.
3. Refuse to check or have no training motivation and requirements at all.
4. Take medications that affect mental activity (including alcohol, drugs, and other stimulants or inhibitors).
ready
1.Albert bar test, word test (Diller test), split line test, sheckenberg test, high-pitched reading test.
2. Paper, pen.
3. Explain the purpose, examination method and precautions to the patient before the examination to fully obtain the cooperation of the patient.
4. Data collection of clinical specialty data and patient personal history, living environment data.
method
1. Preliminary observation of the general cognitive status of the patient.
2. Evaluation method
(1) Specific inspection steps:
1Albert Stroke Test: The test consists of 40 2.5cm long short lines regularly distributed in different directions on the left, center and right of a 16-open white paper, allowing the patient to cross all the lines.
2 Scratch Test (Diller Test): The Diller test is to let the patient delete the specified letters and numbers, which appear randomly on each line of a piece of paper.
3 Painting test: Give the patient a picture, let the patient imitate the painting; or say an item for the patient to draw. More applications are painting houses, bicycles and daisies, as well as clocks, stars and so on.
4 bisect line test: There is a line segment on the paper, so that the patient marks the midpoint of the line segment. The Sheckenberg test: 20 strips of different lengths on a piece of paper, arranged irregularly, and appearing differently in the space on the paper.
5 loud reading test: give a short essay for the patient to read a paragraph of text.
6 Writing test: dictation or transcript of a short essay.
7 Ask the patient how much they know about their illness.
8 orientation: The assessor calls the name of a part of the left or right side of the body, and the patient lifts the corresponding part as required, or the assessor points to one of the patient's side hands, and the patient answers that this is his left hand. Still right hand, the one who answered incorrectly is positive.
9 finger misidentification: let the patient know the name of each finger before the test, and then the assessor exhales the names of the fingers on the right or left index finger, little finger, etc., and asks the patient to raise his corresponding finger or let him point out the examiner. The corresponding finger. Those who answered incorrectly were positive. Generally, the middle 3 fingers are prone to errors.
10 Lost writing: Let the patient write a short sentence dictated by the examiner, and the writer cannot write a positive for the loss of writing.
Miscalculation: Let the patient's mental arithmetic or simple arithmetic.
(2) Evaluation indicators:
1Albert bar test: no neglect: miss 1 or 2; can be ignored: missed 3 ~ 23; single side ignored: missed >23.
2 Scratch test (Diller test): One-sided neglect: Missing the letter or number specified on the side.
3 Painting test: One-sided neglect: the display side is obviously missing or skewed.
4 bisector line test: can show a line in the middle of the judgment error, the midpoint offset distance is more than 10% of the full line length is positive, Sheeckenberg test: unilateral miss 2 lines are positive.
5 loud reading test: spatial dyslexic performance in the reading of another line of difficulty, often miss the left half of the letters and syllables, when reading compound words or numbers, as the number of words can be observed the same type of abnormalities.
6 writing test: patients with neglect showed obvious writing difficulties.
7 The disease is unrecognized: the patient does not admit that he is sick at all, so he is safe and self-satisfied, and he does not care about himself. The lesions are mostly in the right parietal lobe.
Loss of orientation around 8: The answer is incorrect.
9 finger misidentification: the answer is incorrect. Generally, the middle 3 fingers are prone to errors.
10 lost writing: can not be written as a false positive.
Miscalculation: Patients will have obstacles in both mental arithmetic and written calculations.
Precautions
1. To assess the environment, choose a quiet room to avoid interference.
2. Preparation
(1) After reviewing the patient's background information, the contents of the examination (including utensils) and the order should be prepared in advance according to the patient's condition.
(2) Before the test, the patient or family member should explain the test purpose, requirements and main contents to obtain consent and full cooperation.
3. The examination should be carried out in a harmonious atmosphere. During the examination, observe the patient's condition, whether it is cooperative, and whether it is fatigued.
4. Do not arbitrarily correct the patient's wrong reaction during the examination.
5. The examination should not only record the correctness of the patient's response, but also record the patient's original response (including alternative language, gestures, body language, written expression, etc.).
6. It is best to carry out one-on-one (that is, between the assessor and the patient), and the patient should not suggest or prompt the patient.
7. When the patient's physical condition is not good or the mood is obviously unstable, the patient may not be forced to continue the examination. Standardized system tests are performed at the appropriate time based on patient recovery.
8.Albert bar test, scoring test (Diller test), bisector test, writing test and high-pitched reading test should be placed in front of the patient, not implied.
Diagnosis
Diagnosis of aphasia
diagnosis
Diagnosis is based on clinical manifestations, medical history, and examination.
Differential diagnosis
A variety of causes can cause aphasia, loss of recognition and loss of name are two different psychological barriers, can not be named does not mean that can not be recognized, can be named only a part of cognition, a patient with aphasia The name, description of the use, demonstration of the use method, and matching test of the object and the object can not be completed, and the unnamed patient can correctly complete the use of the article and the above test method, in addition to the name, so the two need to be identified.
(a) cerebrovascular disease (cerebravascular disease)
The occipital lobe and temporal lobe supply blood mainly from the middle cerebral artery, the posterior cerebral artery and its branches. Arterial occlusion can cause corresponding clinical manifestations, and typical simple agnosia can occur when the extent of the lesion is limited. However, the range of lesions with aphasia is often extensive, generally secondary to post-stroke performance, and other clinical manifestations of middle cerebral artery disease. Agnosia can be detected in diseases such as cerebral infarction, cerebral arteritis, and cerebral artery venous malformation.
(2) Brain tumor (intracranial tumour)
The occipital lobe tumor is mostly glioblastoma, sometimes astrocytoma, and has clinical hemianopia and visual hallucinations. When the lesion is in the dominant hemisphere, there may be sensory aphasia, loss of reading and color misrecognition, and loss of recognition at the same time. Non-dominant hemispheres are subject to disappearance and visual space loss. The early stage of temporal lobe tumor is asymptomatic, and the temporal lobe seizure may occur with the development of the disease, mainly due to psychomotor seizures. There is a contralateral 1/4 field of view defect and auditory agnosia, and the main side involvement can cause sensory aphasia. Most of the parietal tumors are metastases, and the clinical manifestations are mostly sensory disturbances, which may include sensory ataxia, decreased muscle tone, muscle atrophy and tactile inattention. Non-main hemisphere involvement may have apathy and autism. Gerst-mann syndrome can occur with primary involvement.
(3) Trauma
Brain contusion and intracranial hematoma occurring in the sac, apex, and occipital lobe can cause aphasia.
(4) intracranial infection (intracranial infection)
Otogenic brain abscess accounts for more than half of all brain tumors, most of which are located in the middle and lower part of the temporal lobe, or in front of the cerebellar hemisphere. Blood-borne infections are more common in the arterial supply area of the arteries, and autism may occur in focal symptoms of the nervous system. Patients may have primary lesions such as paranasal sinus, middle ear, mastoid, skull infection, lung abscess, empyema or congenital purpura heart disease. There may be fever at the beginning of the disease, and the granulocytes and proteins in the surrounding blood are increased. CT has a diagnostic value. Others such as encephalitis, neurosyphilis, brain parasites, etc. can also cause agnosia.
(5) Others
Pick disease is a kind of degenerative brain disease. In the initial stage, personality and emotional volition disorder are the main symptoms, and the mental decline is not obvious. Late mental decline, lack of initiative, lack of speech, less movement, systemic failure and even death. The course of the disease is up to ten years. Clinical and Alzheimer's disease is difficult to identify. There is data to confirm the increase in zinc concentration in the brain. Urinary zinc excretion also increased. In the early stage of the onset, the intelligent decline is not serious. It may not be highlighted by visual recognition, or the body image loss syndrome may be found. Autism can also be detected by Alzheimer's disease, carbon monoxide poisoning, and the like.
