title: Anosognosia for hemiplegia: The contributory role of right inferior frontal gyrus.
abstract: OBJECTIVE
  Awareness of motor functioning is most likely a complex process that requires integration of sensory-motor feedback to constantly update the system on the functioning of the limb during motor behavior. Using lesion mapping procedures and behavioral measures, the current study aimed to evaluate neural correlates of anosognosia for hemiplegia (AHP) in the acute stage (first 48 hr) of right hemisphere stroke.
  
  
  METHODS
  Thirty-five individuals with right hemisphere stroke who presented to an urban medical center within 24 hr of symptom onset were included in the study. All 35 individuals had hemiplegia, and 8 of these individuals exhibited AHP.
  
  
  RESULTS
  Fisher's exact test statistical map of lesion-deficit association (range is between-log(p) 4 to 11) found maximal value of 10.9 located in pars orbitalis (Brodmann's Area 47; BA). In this selected location, 6 out of 8 patients with AHP had tissue abnormality, whereas none of the unaffected subjects had tissue abnormality in BA 47. Right BA 44/45 was also found to be lesioned more frequently in individuals with AHP (75%) than without AHP (11%).
  
  
  CONCLUSIONS
  The current study findings provide preliminary support for unique involvement of the right inferior frontal gyrus (IFG), pars orbitalis (BA 47) in AHP. The current data suggest that frontal operculum may play a key role in awareness of limb functioning.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Kortte
authors.affiliation: Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences.
authors.forename: Jessica Wolfman
authors.initials: JW
authors.lastname: McWhorter
authors.affiliation: Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences.
authors.forename: Mikolaj A
authors.initials: MA
authors.lastname: Pawlak
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine.
authors.forename: Jamie
authors.initials: J
authors.lastname: Slentz
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine.
authors.forename: Sandeepa
authors.initials: S
authors.lastname: Sur
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine.
authors.forename: Argye E
authors.initials: AE
authors.lastname: Hillis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000377:Agnosia / Q000209:etiology / Q000473:pathology*; D001364:Awareness; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D006429:Hemiplegia / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications / Q000473:pathology*