Is Anosognosia for Left-Sided Hemiplegia Due to a Specific Self-Awareness Defect or to a Poorly Conscious Working Mode Typical of the Right Hemisphere?

Abstract

This review aimed to evaluate whether the association between ‘anosognosia for hemiplegia’ and lesions of the right hemisphere points to a special self-awareness role of the right side of the brain, or could instead be due to a working mode typical of the right hemisphere. This latter viewpoint is consistent with a recently proposed model of human brain asymmetries that assumes that language lateralization in the left hemisphere might have increased the left hemisphere’s level of consciousness and intentionality in comparison with the right hemisphere’s less conscious and more automatic functioning. To assess these alternatives, I tried to ascertain whether anosognosia is greater for left-sided hemiplegia than for other disorders provoked by right brain lesions, or whether unawareness prevails in tasks more clearly related to the disruption of the right hemisphere’s more automatic (and less conscious) functioning. Data consistent with the first alternative would support the existence of a specific link between anosognosia for hemiplegia and self-awareness, whereas data supporting the second option would confirm the model linking anosognosia to a poorly conscious working mode typical of the right hemisphere. Analysis results showed that the incidence of anosognosia of the highly automatic syndrome of unilateral neglect was greater than that concerning the unawareness of left hemiplegia, suggesting that anosognosia for left-sided hemiplegia might be due to the poorly conscious working mode typical of the right hemisphere.