Зрительная агнозия в клинике острого ишемического инсульта: частота встречаемости и связь с другими когнитивными нарушениями

Abstract

Study Objective: To identify the frequency of the types of visual agnosia (VA), their association with one another and with other neuropsychologic disorders in patients with acute hemispheric non-lacunar ischemic stroke (IS). Study Design: retrospective study. Materials and Methods. We followed up 104 patients with acute IS (mean age: 66.7 ± 9.4 years old), who underwent neurological, neuropsychologic, neuroimaging and ophthalmological examination. Study Results. VA was diagnosed in 52% of patients; in the majority of cases, the condition was diagnosed on the basis of deep neuropsychologic tests only, and it was asymptomatic. VA structure was dominated by unilateral visual neglect (21%), apraxia (20%) and object VA (18%). Object VA was the most frequent clinical sign (8 (42%) out of 19 patients). Spatial VA (including neglect and apraxia) correlated with the rate of regulatory dysfunction and short-term visual memory impairment; object VA — with regulatory dysfunction; facial VA — only with a decrease in short-term visual memory. The cluster analysis allowed identifying relatively homogeneous groups of patients: 1) no VA; 2) impaired spacial gnosis; 3) with impaired objects and facial gnosis. Conclusion. VA is diagnosed in a half of patients with acute hemispheric non-lacunar IS and is mostly asymptomatic. Spatial VA is predominant. Spacial, object and facial VA have statistically significant association with frontal lobe dysfunction; spacial and facial — with short-term visual memory impairments. Two most common combinations of various VA types in acute IS were identified — visual and special disorders and impaired object and face recognition. Keywords: visual agnosia, visual and spacial disorders, stroke, cluster analysis.