Asomatognosia impairs body perception. Patients no longer feel a section of their own body belongs to them because of lesions in the parietal lobe. Because of the lack of insight into the condition, treatment is considered difficult.
What is asomatognosia?
In medicine, asomatognosia is a lack of ability to perceive one’s own body parts that has an underlying physical cause. The term literally means “not knowing” about one’s own body. In most cases, patients simply have no sense of the affiliation of their own body parts. Patients are also often unable to perceive diseases of the affected extremities due to the lack of a sense of belonging. Asomatognosia affects either only one or both sides of the body. Most often, the left side of the body is affected, as a lesion of the right parietal lobe is considered to be one of the most common causes of the phenomenon. There are different types of asomatognosia. In addition to allesthesia and anosognosia, the most common forms include anosodiaphoria, asymbolia, autotopagnosia, and pain asymbolia. Asomatognosia is usually accompanied by other neurological deficits. Thus, as a rule, the symptoms do not occur in isolation but as part of an entire syndrome and may also affect extremely localized sections of the body.
Causes
Asomatognosia is usually preceded by right hemispheric lesions of the parietal lobe. The parietal lobe is home to the so-called Brodmann areas. This area of the brain plays a role in combining sensory information from the individual sensory channels and is thus involved in both spatial perception and body navigation through space. Thus, the parietal lobe primarily serves orientation, determines the environment, and incorporates the environmental images into a motor strategy. The most common cause of lesions in this area of the brain is cerebral infarction. Hemorrhage of the middle cerebral artery can also trigger the symptoms. The corresponding section of the parietal lobe can also be damaged by inflammation. Causative cerebral infarctions and hemorrhages, however, are more common. Among the rarest are causative cysts or tumors in the parietal lobe area. Specifically, asomatognosia due to hemorrhages and cerebral infarcts can cause entire syndromes such as Anton’s syndrome, in which the patient cannot see his own blindness due to the brain lesions. Some asomatognosias are located in the frontal lobe instead of the parietal lobe or, in the case of Anton syndrome, directly in the visual pathways.
Symptoms, complaints, and signs
As a form of asomatognosia, pain asymbolia is manifested by a local absence of pain perception that impairs understanding of the triggering pain. Thus, the pain is felt, but because of the lack of understanding of its biological significance, no appropriate defensive responses take place. In autotopagnosia, the patient can no longer locate or name his or her own body parts. In contrast, asymbolia due to lesions in Brodmann areas 5 and 7 impairs the general understanding of all representative signs. Allesthesia prevents the patient from assigning stimuli to the correct parts of the body. Two special forms of asomatognosia are anosognosia and anosodiaphoria. In anosognosia, the patient is unable to perceive his or her own bodily deficits, and anosodiaphoria causes the patient to feel indifference to his or her own illness. Symptoms may overlap or socialize with other neurological symptoms, such as paralysis, deafness, or blindness. Rotational vertigo also refers to lesions in the inferior parietal lobe. Lesions in the lateral parietal lobe are often associated with speech disorders.
Diagnosis and course
The diagnosis of asomatognosia is made primarily by history, psychiatric evaluation, and brain imaging. Often, this is an incidental finding, as patients do not seek medical attention for a condition they are completely unaware of. In the case of Anton’s syndrome, for example, the affected persons do not appear at the doctor’s because of the blindness that has occurred, but because of accompanying neurological symptoms. When their blindness is then revealed to them, they deny the disease because they feel they can still see.The course of asomatognosia depends on the cause and timing of diagnosis and treatment.
Complications
In general, asomatognosia results in severely diminished pain perception. The patient cannot independently decide whether certain parts of the body are in pain or not. As a result, there is an increased risk of illness and accidents. Also, the biological defense reactions are limited because the pain sensation is no longer active. In some cases, stimuli are also not assigned to the correct parts of the body. Thus, pain can be felt in the wrong places, leading to false conclusions. In many cases, patients also suffer from hearing loss and visual problems. It is not uncommon for those affected to also experience difficulty speaking and paralysis in certain parts of the body. In most cases, psychological treatment is sought for asomatognosia. However, this can take several months, as it is often not easy to convince the patient of a certain disease. It is usually impossible to predict whether further complications will arise in the process. If asomatognosia is not treated, in many cases cancers and cysts develop. Those affected also suffer from an increased risk of accidents. As a rule, life expectancy decreases with asomatognosia.
When should you see a doctor?
In many cases, asomatognosia is diagnosed in children. Especially the parents must thereby point out the disease to the doctor, so that he can make a diagnosis. As a rule, the doctor should be consulted when the affected person’s sense of pain no longer functions properly. Pain can be perceived either too strongly or too weakly. Particularly in children, asomatognosia can thus lead to developmental disorders and impaired growth. It is not uncommon for speech disorders to occur as well. A doctor must be consulted if the patient complains of paralysis or other sensory disorders. It is not uncommon for blindness or deafness to occur. Rotational vertigo may also be a symptom of asomatognosia and must be examined by a physician. As a rule, the first examination and diagnosis is made by a general practitioner. The individual symptoms and complaints are treated by a specialist, although in most cases complete treatment is not possible.
Treatment and therapy
Treatment of asomatognosia proves difficult. Because sufferers often lack insight into the condition and thus cannot comprehend it from their own experience, they often refuse therapy and sometimes even react aggressively to the diagnosis of asomatognosia. Insight into the disorder is the first starting point for treatment. This usually requires psychotherapeutic intervention in which the patient is regularly reminded of the deficit. Untreated asomatognosia may result in neurological deterioration, depending on the cause of the disease. Such deteriorations particularly involve causative space-occupying lesions, such as cysts and tumors. In addition, if the patient of an asomatognosia no longer perceives one side of the body as belonging to him, this entails high risks of injury for the affected side of the body. Only an early realization of the deficits can prevent subsequent injuries. The further treatment of asomatognosia is carried out after the insight of the disease depending on the respective cause. Cysts and tumors must be surgically removed. In cases of hemorrhage, it is important to prevent recurrences. Special therapies are available for syndromes such as Anton’s syndrome. Today, targeted light pulses can largely reverse the cortical blindness of this disorder, provided that prompt treatment is given.
Outlook and prognosis
The prognostic outlook for asomatognosia must be considered less than optimistic. The patient’s lack of insight into the disease often makes treatment or medical care impossible. In order for treatment to be initiated, the patient’s consent is needed. This is rarely available due to a lack of insight or is withdrawn shortly after the start of treatment. For a change in the situation, participation in psychotherapy is recommended. Few patients agree to this either, as they do not perceive any feeling of illness.If consent is given due to the influence of a guardian, strong resistance from the patient is to be expected. This leads to severe delays or a counterproductive outcome. Without treatment, an increase in asomatognosia is to be expected. The disease progresses and more symptoms occur. In severe cases, irreparable damage occurs. In the best case, the patient agrees to treatment and actively cooperates in the healing process. Here the improvement depends on the physical cause. However, a complete cure is still questionable. In the case of tumor disease, surgical intervention must be performed. The subsequent therapy and the nature of the tumor are crucial for a possible cure. In the case of hemorrhage, there are possibilities for relief. Nevertheless, there is also a risk of fatal disease progression.
Prevention
Asomatognosia itself cannot be directly prevented. However, causative diseases such as tumors or strokes can be prevented in moderation by a healthy lifestyle and regular checkups.
Aftercare
In most cases, asomatognosia does not provide the affected person with any options for aftercare. The condition also cannot be fully treated, as it is largely unexplored at the present time, so only purely symptomatic treatment can take place. However, a therapy with the help of a psychologist can alleviate the symptoms of asomatognosia, so that it is recommended to the person affected. Likewise, early diagnosis and treatment of asomatognosia has a positive effect on the further course of the disease and can prevent possible complications. In some cases, tumors can also be responsible for asomatognosia. In such cases, these must be removed by surgical intervention. After such an operation, the patient must rest and take care of his body. Unnecessary exertion and sports activities should be avoided. Furthermore, regular examinations are also useful to avoid the recurrence of tumors. Loving care and support of the patient by friends and family is also useful and can make the life of the affected person much easier. In some cases, contact with other patients of asomatognosia can also be helpful, as it can lead to an exchange of information.
What you can do yourself
Those suffering from asomatognosia have no means of combating the disease causally through self-help measures. To make matters worse, most sufferers lack insight into their condition. In this case, it is up to the family member to take appropriate measures to encourage the patient to undergo therapy and to organize everyday life in such a way that the risk of accidents is minimized. Inconsistent patients should be sensitively but consistently made aware of their suffering by those around them. If asomatognosia causes a patient to neglect one half of the body or certain parts of the body, this can be done relatively easily. In these cases, the patient should be photographed and immediately confronted with the photographs. The state of partial neglect can then no longer simply be rationalized away. The method is also helpful when body parts that are not perceived show clearly visible injuries, especially blue-black discolored hematomas. Constant confrontations of this kind can lead to the patient finally acknowledging his suffering and agreeing to treatment. Since the affected person himself does not perceive injuries or does not correctly assign pain, relatives must regularly physically examine the affected person. Otherwise, there is a risk that fractures, especially of the hands or feet, will remain undetected and the bones will grow together crookedly. Pointed furniture and other objects that are associated with an increased risk of accidents should be removed from the home.
