Unawareness of deficits in ischemic injury: Role of the cingulate cortex

Abstract

Reduced awareness of illness is a well-known phenomenon that has been studied in patients with vascular disease, but the precise nature of their executive dysfunction is an intriguing question that still has to be resolved. It would be particularly interesting to study patients with reduced awareness of disease possibly related to vascular lesions of the prefrontal cortex. Due to the clinical importance of the case, here we present a patient with a selective right anterior cingulate ischemic injury and impaired awareness of deficits. We suggest that the cingulo-frontal area dysfunction may represent one of the corresponding neurobiological substrates of his persistent unawareness, which has not yet been evaluated in the literature on patients with acquired brain injury (ABI).

Keywords:

• Anterior cingulate cortex
• Unawareness of deficits
• Executive function assessment
• Behavioral assessment of the dysexecutive syndrome
• Case study

Notes

1. ¹The term “anosognosia” is used to describe a failure in recognizing the presence of neuropsychological impairment at the modular functions level (perception, action language: anosognosia for emiplegia, for unilateral neglect, for fluent aphasia).

2. ²As Amodio and Frith (2006) have suggested, medial frontal cortex (MFC) is referred to a network of brain regions including anterior cingulate cortex (ACC), the temporoparietal junction, the superior temporal sulcus and the temporal poles.