Vertical neglect

Introduction 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 refers to the middle The points are obviously moving upwards. Bilateral occipital lobe lesions can occur in the vertical type of polymorphic neglect. It is a symptom of neglect.

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. Sensory neglect and unilateral spatial neglect, often caused by non-dominant hemispheres under the lobule or posterior thalamic lesions, also found in the dominant hemisphere parietal, frontal and lateral dorsolateral, basal ganglia and posterior sac Lesion. The most common cause of neglect is cerebrovascular disease, which is also seen in patients with brain tumors, brain trauma, and brain stereotactic destruction.

an examination

Classification and lesions:

1. Motor neglect: A patient uses only one hand to do the right hand to do things and gestures, while the other hand usually has the left hand seems to have been forgotten and left idle. The arm does not swing or rarely swings, like a patient with a half-side Parkinson's disease, 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.

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. This is a neglect of exercise.

A valuable sign common in the disease.

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

2. 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.

Differential diagnosis

Sensory neglect: 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.

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.

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