Anosognosia and major depression in 2 patients with cerebrovascular lesions

At first glance, anosognosia seems quite peculiar. Anosognosia is the inability of the patient to recognize an impairment. It is most common in strokes of the right, or nondominant, hemisphere, which produce hemiparesis on the left side of the body. In cases involving a right-side stroke and anosognosia, the patient is unaware of the deficit on the left side of the body. While the condition might be considered to be a form of hemineglect, in which the patient pays little attention to the left side of his world, cases of anosognosia without hemineglect have been observed, as well as cases of hemineglect without anosognosia. Many patients with anosognosia are quite cheerful, which seems to be consistent with their inability to perceive their deficit. Some researchers have gone so far as to state that major depression, which is common among stroke victims, cannot co-exist with anosognosia. However, two recent cases illustrate that this is not true. Both patients suffered cerebrovascular lesions in the right hemisphere; an infarct in one patient and a hemorrhagic lesion in the other. Both patients developed syndromes that included hemineglect of the left world, anosognosia, left sided hemiparesis or weakness, and major depression immediately following their cerebrovascular accident. In one patient the hemineglect and anosognosia resolved within two months, but the depression persisted; in the other the depression responded to treatment with nortriptyline, but the neglect and anosognosia persisted much longer. Both the existence of the cases and the fact that the depression and other deficits had different time courses in each patient, indicate that major depression and anosognosia are independent consequences of stroke and may occur separately or together. (Consumer Summary produced by Reliance Medical Information, Inc.)