Asymbolia for pain: A sensory-limbic disconnection syndrome

Authors

  • Dr. Marchcelo Berthier MD,

    Corresponding author
    1. Dr Raul Carrea Institute for Neurological Research-FLENI, Buenos Aires, Argentina
    • Instituto de Inves-tigaciones Neurologicas Dr Raul Carrea-FLENI, Ayacucho 2166, 1112, Buenos Aires, Argentina
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  • Sergio Starkstein MD,

    1. Dr Raul Carrea Institute for Neurological Research-FLENI, Buenos Aires, Argentina
    Current affiliation:
    1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Meyer Building 4-119, Baltimore, MD 21205
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  • Ramon Leiguarda MD

    1. Dr Raul Carrea Institute for Neurological Research-FLENI, Buenos Aires, Argentina
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Abstract

We describe the behavioral and neuroanatomical features of asymbolia for pain occurring in 6 patients following unilateral hemispheric damage secondary to ischemic lesions in 5 and traumatic hematoma in 1. In the absence of priMarchy sensory deficits, these 6 patients showed a lack of withdrawal and absent or inadequate emotional responses to painful stimuli applied over the entire body, as well as to threatening gestures. Five patients also failed to react to verbal menaces. Patients appeared unconcerned about the defect and seemed unable to learn appropriate escape or protective responses. Common associated abnormalities were rapidly resolving hemiparesis, cortical-type sensory loss, unilateral neglect, and body-schema disorders. Neuroradiological examination disclosed left hemispheric lesions in 4 patients and right hemispheric involvement in 2. Although lesion extension differed, the insular cortex was invariably damaged in all 6 patients. These findings suggest that insular damage may play a critical role in the development of the syndrome by interrupting connections between sensory cortices and the limbic system.

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