Motor neglect disorder

Introduction Motor neglect (motorneglect) patients only use health search one hand is often the right hand to do things, and gestures while the other hand is usually the left hand, seems to be forgotten and left idle, so when walking, the affected side The arm health search does not swing or rarely swings the health search, like a half-side Parkinson's disease patient, and remains motionless for a long time when the affected arm is in a very uncomfortable position. The neglect of the lower limbs is manifested by the obstacles on the affected side when walking. When a pair of shoes are placed in front of him, he is asked to wear only one of the healthy side and ignore one of the affected side.

Cause

The neglect is caused by the lesion of the right parietal lobe. The motor neglect is also seen in the lateral or lateral aspect of the frontal lobe, as well as the cortical or subcortical lesions in the temporal region, lesions in the thalamus, caudate nucleus, putamen and internal capsule. Can also cause exercise neglect.

an examination

Related inspection

Nervous system examination

Motor neglect The patient uses only one hand to do the right hand to do things and gestures, while the other hand usually seems to have been left behind by the left hand and is left idle. Or rarely swing, like a patient with a half-side Parkinson's disease, and remain motionless for a long time when the affected arm is in a very uncomfortable position. The neglect of the lower limbs is manifested by the obstacles on the affected side when walking. When a pair of shoes are placed in front of him, he is asked to wear only one of the healthy side and ignore one of the affected side.

The method of examination for exercise-induced neglect is to make the patient perform double-sided repetitive movements. For example, the patient is required to open and hold the two fists at the same time for 20 consecutive times. The normal person can perform repeated simultaneous movements without error, and the patient has one side. Do it continuously and do not do it on the other side or obviously leak it.

When the stimulus ignores the side limbs, whether it is acupuncture, licking or pinching the skin, or flexing the side ring finger hard, the patient will say pain, but it does not retract the hand; thus the patient is not harmless. The perception of stimuli is an obstacle, but a barrier to responding to noxious stimuli, a valuable sign common in motor ignorance.

Clinically, pure motor neglect is rare, often with a certain degree of sensory neglect, but always with obvious dyskinesia and mild sensory disturbance.

Differential diagnosis

Different types of identification with neglect:

1. Sensory neglect: Sensory neglect, also known as hemi-inattention, can be somatosensory, visual or auditory, in which case the patient cannot target the stimulus from the lesion side. No response or report; the patient's lesion does not destroy the sensory afferent pathway or damage the primary sensory cortex or the thalamic sensory nucleus.

Sensory neglect is usually expressed in the form of sensory extinction. The definition of sensation subsidence is that when the same stimulus is given to both sides, the patient does not feel the stimulation on one side; but the patient can feel it when giving the left and right side stimulation respectively.

2. Hemi spatial neglect: also known as hemi spatial inattention or unilateral visual neglect. Lateral space neglect is often accompanied by left-sided isotropic hemianopia, but the latter is not essential.

Patients with unilateral spatial neglect, manifested as one side of the thing, often in the left side of the field of things do not pay attention: ask him to read a newspaper in the column heading, he read only the right half and ignore the left half; Ask him to count the number of people standing in front of his bed. He only counted the right and front, and ignored the person on the left.

3. Vertical neglect: The patient does not see the lower part of the object in front, and the vertical direction of the wood is measured by visual, tactile, and visual-tactile bisects. Compared with the normal control, the patient The midpoints indicated were significantly shifted upwards. Bilateral occipital lobe lesions can occur in the vertical type of polymorphic neglect. Some scholars believe that neglect can be classified as aphasia in cognitive impairment. Objectively speaking, neglect is very similar to self-contained and spatially unrecognized. Therefore, clinical diagnosis and identification are not easy. The identification points are also similar to the misidentification. The patient does not have visual, auditory, physical sensation and disturbance of consciousness. Nervous system examinations must be done carefully, excluding some of the abnormalities caused by other aspects of the cupping net.

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