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M65  Unconscious Sensor y Per ception                             in    a Case of Hemine glect                       Autho...
Objective and Background   To describe dissociation between various    tests of personal neglect and to    demonstrate   ...
Designs/Methods Case vignette Indrani. 50 year old female Presents   with sudden onset of weakness  of left upper and low...
   CT Brain – P – Shows a (R)    Occipitotemporal infarct
Higher mental function evaluation   MMSE : 28/30   She was very attentive and quite clear in her    conversation with us...
Designs/MethodsOur patient had (L) hemiplegia, (L)somatosensory loss with (R)temperooccipital infarct.Neuropsychological e...
On cold caloric tests and its      effect on neglect
Video of Neglect
Video of caloric test and Nystagmus
Video of disappearance of neglect
On ‘ Mirror Agnosia’Mirror Agnosia on the Right
After caloric test, Mirror Agnosia             on the Left
‘Mirror Agnosia’ to front
 On Anosognosia, Body neglect  (Hemisomatognosia) and  somatoparaphrenia Anosognosia – our patient has it Body neglect ...
Somatoparaphrenia
On the somatophrenic arm and mirrors
   On Allesthesia, tactile neglect and    ‘blind touch’   ‘Touch your left arm’ Bisiach’s test of    body neglect.   Ab...
Blind Sight Vs Blind Touch
   On visual imagery, neglect and caloric    tests   Visual imagery   Bisiach’s test   Our test
Results
Results   Our patient had personal neglect on    tests of attention to the left half of her    body with anosognosia grad...
Results Cont..      We show unconscious sensory    perception in a patient with sensory    loss, somatophrenia and neglec...
Discussion   Neglect – Cognitive inability to response to contralesional    stimulus – Robertson and Marshall   Blindsig...
Discussion cont..      By showing unconscious sensory    perception in a patient with sensory loss,    somatophrenia and ...
Unconscious awareness in a person with           Blind Sight               And           Blind TouchConscious mind and unc...
Conclusion   We     show      unconscious     sensory    perception in a patient with sensory loss,    somatophrenia and ...
Unconscious sensory perception in a case of hemineglect
Unconscious sensory perception in a case of hemineglect
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Unconscious sensory perception in a case of hemineglect

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Transcript of "Unconscious sensory perception in a case of hemineglect"

  1. 1. M65 Unconscious Sensor y Per ception in a Case of Hemine glect Authors: Ramachandran S. Vilayanur Srinivasan V. AvathvadiBijoy K. Menon, Nithyanandam V. Allimuthu, Diane R. Rogers Monday, October 9, 2006 Poster Session II
  2. 2. Objective and Background To describe dissociation between various tests of personal neglect and to demonstrate unconscious sensory perception. Personal neglect is tested by Bisiachs test or by tests of attention to the left half of body. Normally these tests are congruent
  3. 3. Designs/Methods Case vignette Indrani. 50 year old female Presents with sudden onset of weakness of left upper and lower limb O/E.  Conscious, oriented to time, place and person  Mild left UMN facial paresis  Left hemiplegia  All peripheral pulses palpable
  4. 4.  CT Brain – P – Shows a (R) Occipitotemporal infarct
  5. 5. Higher mental function evaluation MMSE : 28/30 She was very attentive and quite clear in her conversation with us, though she would be complaining of a vague left sided shoulder painOn lobar testing, she had Left visual neglect with (L) hemianopia No auditory neglect Absent sensory perception in (L) upper limb and (L) tactile neglect in the lower limb
  6. 6. Designs/MethodsOur patient had (L) hemiplegia, (L)somatosensory loss with (R)temperooccipital infarct.Neuropsychological evaluation revealedthe following.
  7. 7. On cold caloric tests and its effect on neglect
  8. 8. Video of Neglect
  9. 9. Video of caloric test and Nystagmus
  10. 10. Video of disappearance of neglect
  11. 11. On ‘ Mirror Agnosia’Mirror Agnosia on the Right
  12. 12. After caloric test, Mirror Agnosia on the Left
  13. 13. ‘Mirror Agnosia’ to front
  14. 14.  On Anosognosia, Body neglect (Hemisomatognosia) and somatoparaphrenia Anosognosia – our patient has it Body neglect by Bisiach’s test – our patient does not have it Somatoparaphrenia – our patient has it
  15. 15. Somatoparaphrenia
  16. 16. On the somatophrenic arm and mirrors
  17. 17.  On Allesthesia, tactile neglect and ‘blind touch’ ‘Touch your left arm’ Bisiach’s test of body neglect. Absent proprioception and touch in the left upper limb Patient is still able to touch her left arm whatever position the examiner keeps the arm in.
  18. 18. Blind Sight Vs Blind Touch
  19. 19.  On visual imagery, neglect and caloric tests Visual imagery Bisiach’s test Our test
  20. 20. Results
  21. 21. Results Our patient had personal neglect on tests of attention to the left half of her body with anosognosia grade I and severe somatophrenia of her left arm. Intriguingly, when asked to point to her left eye she grasped her left hand with her intact right arm and used it to touch her eye showing tacit knowledge of paralysis despite anosognosia and somatophrenia.
  22. 22. Results Cont.. We show unconscious sensory perception in a patient with sensory loss, somatophrenia and neglect. This is a new phenomenon similar to blind sight.
  23. 23. Discussion Neglect – Cognitive inability to response to contralesional stimulus – Robertson and Marshall Blindsight – Weiskrant et al., 1974 – Interesting question is: if the parients can ‘see’ the stimulus enough to point to it, why aren’t they consciously aware of it? Patient with Unilateral neglect – Unilateral neglect is, in a sense, the opposite side of this coin. – A patient with neglect fails to respond and report objects and stimuli presented in the region opposite to the lesion site, but has an otherwise intact visual field.
  24. 24. Discussion cont.. By showing unconscious sensory perception in a patient with sensory loss, somatophrenia and neglect, we suggest that this is a new phenomenon similar to blind sight and raises questions about unconscious sensory perception.
  25. 25. Unconscious awareness in a person with Blind Sight And Blind TouchConscious mind and unconscious mindTheories of consciousness and the soul.
  26. 26. Conclusion We show unconscious sensory perception in a patient with sensory loss, somatophrenia and neglect. This is a new phenomenon similar to blind sight and raises questions about unconscious sensory perception.
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