Physiologists have always regarded animal psychology with a certain distrust. It was believed that to penetrate the thoughts of creatures that did not have a language, and not a single animal - neither the silent intellectuals of the sea, dolphins, nor the talented imitators of sounds, talkative parrots - could master speech. Speech is ranked among the main, most important differences between humans and animals. And although from time to time there are scientists who undertake either to teach the four-legged inhabitants of our planet the language, or to find among them such highly developed creatures who secretly from us, humans, have long been using speech, they have not been able to shake skepticism for a moment. Even when articles about "talking" monkeys flashed on the pages of newspapers and an unimaginable journalistic boom began, the high academic spheres remained coldly indifferent. Chimpanzee language training proved to be such an unscientific problem that there was no desire to come up with a rebuttal about the hype.

In 1859 Charles Darwin finished the most important work of his life "The Origin of Species". Its main task was to show the community between animals of different levels of development, as well as between animals and humans. To do this, Darwin collected unique material confirming the similarities in body structure, behavior and psyche.

There are, of course, differences. It is not for nothing that Darwin's followers, convinced of the origin of man from animals, have long become accustomed to the idea of ​​a huge abyss between us and ours. smaller brothers, which was formed when our distant ancestor climbed down from the tree and began to learn to walk on two legs. This version was quite suitable for the Christian church. According to her pillars, she irrefutably testified to the divine origin of man and completely discredited Darwinism.

The "talking" monkeys were unable to break this barrier. Meanwhile, chimpanzees in a very short time accumulated a vocabulary comparable to the volume of words that two-three-year-old children have, and mastered the skill of constructing phrases from two or three or more words. The monkeys turned out to be able to come up with new words themselves, understand metaphors and even swear, choosing suitable expressions for this on their own, and yet they could not convince most specialists that the communication system they had mastered can be considered a language.

Without going into the details of the discussion that has arisen on this issue, I will say that, from the point of view of I. Pavlov's theory of higher nervous activity, the success of chimpanzees cannot be called anything other than the initial stage of language mastery, so that in this indicator between an animal and a person there is no irresistible chasm. Chimpanzees most unequivocally rebuffed church dogma in their monkey language.

Success in teaching monkeys to speak spoken did not come immediately. They did not cope with the sound language. But when they guessed to use sign language, things went smoothly. We already know that a person's conversation in sign language is directed by the right hemisphere. How speech is organized in the brain of chimpanzees is still unknown. The speed with which monkeys learn the names of objects and actions and generalize them, extending to all homogeneous objects and actions, shows that many generalizations of a sufficiently high order existed in their brains long before the beginning of learning.

There is no reason to doubt that generalizations and some concepts are also formed in the brains of deaf and dumb people who have never learned any speech skills. But in which hemisphere of the untrained deaf-mute these concepts and generalizations are stored is also still unknown. They should be based on visual images, which means that they can be expected to be produced by a "parasite".

Turning off the function of the right hemisphere does not violate the orientation in time, the subject perfectly remembers the year, month and day, and by looking at the clock face, even if there are no numbers on it, he will tell by the position of the hands what time it is. All this information is stored in speech memory. But the orientation in the situation according to its specific features is disturbed so much that it becomes difficult for the subject to understand the colored landscapes. Instead of simply reporting that the picture is winter, he will answer that since there is snow, then, in all likelihood, it is winter now.

Orientation in space is even more disturbed. Although the subject perfectly remembers that he is being treated at the N.A. Semashko and placed in the seventh ward of the third department, he will not be able to return to it from the treatment room on his own. It would be pointless to ask him how you can get there, or ask him to sketch a plan.

When the focus of the disease is localized in the right hemisphere, patients forget the layout of their apartment, all the more they are not able to navigate in the new environment of the hospital department. They sometimes cannot even find their own bed in the ward on their own. They are completely incapable of sketching a plan of a long-familiar room, drawing from memory such ordinary objects as a kettle or glasses, from childhood well-known animals like a dog or a horse.

Orientation in the space to the left of the patient is especially sharply disturbed. He does not have any impressions of what is there. If he is asked to count the people present in the room, the patient does not notice the persons on the left. In search of the book he needs, he looks through only the right side of the shelves on the rack, he will look for his suit in the right compartment of the closet, and the dishes in the right compartment of the sideboard. In general, for the patient, the left half of the surrounding world and the left half of his own body cease to exist.

The left-hemispheric subject loses the ability to estimate time. He does not know how long he is in the treatment room. To any question, he will most often answer that half an hour has passed, but in fact it may turn out that he was brought here only five minutes ago, or, conversely, he is in the procedural room for more than an hour.

With the defeat of the parietal areas of the right hemisphere, such a specific function as the recognition of individual signs of familiar objects is disturbed. It becomes difficult for the patient appearance determine what material the object presented to him is made of: glass, wood, metal, fabric. The forester, who had worked all his life in a farm near Moscow, fell ill and stopped recognizing tree species. I could not even distinguish a spruce from a birch until I touched the branch and pricked it on the needles. It is interesting that such patients are able to draw pictures, but they cannot draw from memory and often do not recognize what they themselves draw.

Humor is a purely human property. Psychologists attribute it to one of the most important manifestations of highly developed intelligence. Patients with a lesion of the right hemisphere, looking at cartoons, often do not see anything funny in them, even if they are able to describe the situation depicted well enough and fully. Signatures of any nature, accompanying the drawings, greatly facilitate the ability to capture the humorous nature of the image. But the analysis of texts, their meaning and content is a function that belongs exclusively to the left hemisphere. So the emotional assessment of the caricature in this case is entirely due to the help of the linguistically savvy half of our brain.

Is the right hemisphere capable of mental activity, of abstraction? Of course, it is capable, only its abstractions are not connected with logical constructions, are not clothed in words. Like everything right-brain, they are figurative in nature. If we need to create a generalized image of an object that has such a complex shape that it is impossible to find verbal designations for it, this operation is performed in the right hemisphere.

Based on visual images and generalizations, the right hemisphere predicts and extrapolates the further course of events. Crossing a suburban highway and seeing an approaching car, the "parasite", based on the analysis of our own speed and the speed of a car moving along the highway, extrapolates where each of us will be in 3 ... 4 seconds, and makes a conclusion whether to cross the road or first let the car pass ...

The ability to extrapolate the entire circumference along a small segment of the curve is also provided by the right hemisphere. Thanks to his activities, having familiarized ourselves with the construction details of a collapsible house, we can imagine how it will look when assembled. It helps us to choose a suitable cut in the store and quite accurately imagine how a suit made from it will look like. Right-brain abstractions and generalizations are extremely difficult to describe in words. That is why we know so little about them and it is so difficult to tell about them.

Figurative thinking seems to us less fruitful for the analytical perception of the world. For logical comprehension and predicting the further course of events, it has another drawback - the tendency to see the world in black colors. Our right hemisphere may well deservedly be called the "knight of the sad image." It is not for nothing that after its functional shutdown, the mood of the subjects improves sharply. They become more cheerful, smiling, with greater benevolence begin to relate to others, they have a tendency to joke.

The effect of temporarily turning off the right hemisphere on mood shaping is striking. After a right-sided electroshock, the first smile often appears in the subject even before he regained consciousness. How important this effect of electroshocks is, can be judged by the fact that among the patients who need this method of treatment, there are many people with various forms of depression. In combination with drug treatment, electroshock gives a lasting positive effect.

One of the most common symptoms of right-sided brain damage is euphoria, increased joyful mood, a sense of contentment and well-being, accompanied by an optimistic assessment of the environment that does not correspond to objective circumstances. Patients are complacent, they, apparently, are not aware of the severity of their illness, in any case, it does not cause unpleasant sensations in them. In general, these patients do not experience deep tragic experiences that cause suffering in healthy people. Doctors perceive the emergence of anxiety or concern in a patient as a favorable symptom indicating the possibility of recovery.

People are very different from each other in character, temperament, general emotional mood, and each of us has had to experience a change of mood more than once, sometimes seemingly completely unreasonable. Apparently, our emotional mood is determined by the predominance of the tone of one of the hemispheres. Depending on which of the twins prevails, cheerful, optimistic or sad, sad music is ordered, and our daily life flows to its accompaniment.

Some patients have hallucinations. Interestingly, the visual and auditory ones are more likely to occur when the right hemisphere is affected, while the olfactory and gustatory ones are never observed at all when the left hemisphere is affected. And the nature of visual hallucinations is significantly different from similar visions that occur with a disease of the left half of the brain. There is no certainty in them. Patients say that they saw some people who seemed familiar to them, but they did not understand who they were. If hallucinations bring visions of some landscapes, rooms, interiors, patients cannot describe them with sufficient accuracy, cannot decide whether they see these pictures for the first time or whether they have an analogue in the real world. In general, visual hallucinations are most often vague, unclear, vague.

To take on the study of the right hemisphere seriously, it was necessary to step over the psychological barrier, to overcome the idea that it is a complete slacker. The reality has surpassed all expectations. As a result, the right hemisphere was rehabilitated and equalized in rights, with its left brother.

Yes, the right hemisphere lacks many essential purely human functions. Yes, the right hemisphere is mute! But how expressively it knows how to be silent! What liveliness, brightness and persuasiveness can be conveyed to the speeches of his leftist brother! How musical, rich in sounds, poetic and colorful is his world! And it makes no sense to ask the question which hemisphere of the brain is more important for us. A bolt and a nut can only be useful with joint efforts. Alone, they are helpless. They make little sense individually.

Acute ischemic disorders of cerebral circulation are distinguished by etiological heterogeneity: the main reasons for the development of ischemic stroke are atherosclerotic lesions of the main arteries of the head (30-40%), hypertensive vascular changes with the development of lacunar strokes (25-30%) or cardiogenic embolism in cardiovascular pathology (20 -25%). Other causes of cerebral infarction are considered hemorheological disorders, vasculitis and coagulopathy - 10% of cases, as well as unexplained causes of strokes.

Signs of a cerebral infarction of the right hemisphere

Ischemic stroke with localization of the lesion in the right hemisphere of the brain is manifested:

• paralysis of the left side of the body;
• various disorders of perception and sensation (there is a loss of the ability to assess the size and shape of objects with a violation of the perception of the scheme of one's own body);
• loss of memory mainly for current events and actions (with full retention of memory for past events);
• ignoring the left half of the space (left visual field);
• anoagnosia;
• motor or total aphasia (in left-handers);
• cognitive impairment (pathology of attention concentration);
• emotional-volitional disorders and neuropsychopathological syndromes, which are manifested by depressive states, often alternating with carelessness and behavioral disturbances with inadequate emotional reactions - disinhibition, foolishness, swagger, loss of tact and measures with a tendency to flat jokes.

Features of ischemic stroke on the right side

This disease is characterized by polymorphism of signs with a longer period of recovery of lost functions. The right hemisphere is responsible for orientation in space, processing of familiar information, sensitivity and perception of the surrounding world. With thrombosis, embolism or significant spasm of the cerebral vessels of the right hemisphere of the brain, it causes complete or partial paralysis of the left side of the body. There is also a violation of short-term memory - the patient remembers past events well, but does not at all record his recent actions and life events.

Left-handers have a speech center in the right hemisphere, so these patients often have motor or total aphasia and often lose their ability to communicate. Ischemic stroke in the right hemisphere of the brain causes patients to have no sensation of their limbs as part of their own body, or to have more arms or legs.

Extensive stroke of the right hemisphere

With a pronounced lesion of the right hemisphere of the brain, at first, cerebral symptoms prevail over focal, and there is a lightning-fast and sudden (apoplectiform) their occurrence and progression. This type of flow characterizes an acute blockage of a large artery. Within a short time, focal symptoms are also most pronounced and are combined with general cerebral neurological symptoms - loss of consciousness, vomiting, severe headache and dizziness, impaired coordination of movements. Patients abruptly lose the ability to perceive the shape and space, as well as the speed of movement and size of objects, the perception of their body, disorders of swallowing, speech and severe movement disorders (hemiparesis and paralysis of the left side of the body) disappear. Often, patients who have suffered a right-sided ischemic stroke suffer from severe depression and mental inactivity.

Extensive ischemic stroke on the right side of the brain causes severe damage that complicates the patient's life and prognosis, disrupts the normal process of treatment and rehabilitation, and more often causes patient disability and death.

Features of right-sided lacunar strokes

Lacunar ischemic stroke with localization in the right hemisphere of the brain develops against the background of progressive hypertension in combination with diabetes mellitus, vasculitis, toxic and infectious lesions of the cerebral vessels, as well as at a young age in the presence of congenital defects in the walls of blood vessels. It manifests itself in initial stages in the form of transient ischemic attacks or minor strokes, sometimes asymptomatic. General cerebral and meningeal symptoms are not typical for this type of stroke, and focal symptoms depend on the location of the lesion.

The characteristic signs that a lacunar ischemic stroke of the brain has is a favorable outcome with a partial neurological deficit or complete restoration of lost functions, but with repeated lacunar strokes, the size of the ischemic focus increases, and the clinical picture of vascular encephalopathy is formed. There are several types of lacunar strokes - isolated motor stroke, ataxic hemiparesis, isolated sensory stroke and the main clinical syndromes: dysarthria, hyperkinetic, pseudobulbar, mutism, parkinsonism, dementia, and others.

Manifestations of ischemic lacunar strokes

Right-sided isolated motor hemiparesis develops most often when the necrosis focus is located in the posterior third of the posterior thigh of the inner capsule, in the basal sections of the cerebral peduncles and in the pons. It is manifested by weakness in the muscles of the left arm and leg, as well as paresis of the facial muscles on the left. This type of lacunar stroke occurs in 50-55% of cases. In 35% of cases of right-sided lacunar strokes, hemiparesis develops in combination with hemianesthesia - left-sided paralysis of facial muscles, paresis of the muscles of the arm and leg on the left with impairment of all types of sensitivity (pain, tactile, musculo-articular and temperature).

Atactic hemiparesis occurs in 10% of lacunar strokes and develops when the basal parts of the pons varoli or the posterior thigh of the inner capsule on the right are affected. It manifests itself as a combination of paresis of the extremities on the left with cerebellar ataxia. Less common are the "dysarthria and awkward hand syndrome", which is a variant of atactic hemiparesis, "isolated central paralysis of the facial muscles" and the "hemichori-hemiballism" syndrome. The most severe manifestation of lacunar cerebral infarctions is a lacunar state - the formation a large number lacunar strokes in the cerebral hemispheres with severe pathology of cerebral vessels and with a significant increase in blood pressure. This ischemic stroke is a manifestation of hypertensive angioencephalopathy.

Ischemic stroke in children and adolescents

Currently, in pediatric practice, there is an increase in complex cerebrovascular pathology and an increase in the number of strokes in children and adolescence, and the consequences of strokes are extremely difficult for both patients and their parents. There is a fairly high mortality rate in the development of ischemic strokes in children - from 5 to 16%. The reasons for the increase in cerebral circulation disorders in children are progressive severe cardiovascular diseases (congenital heart defects, arrhythmias, rheumovasculitis, atrial myxoma), hereditary and acquired angiopathies of cerebral vessels (arteriosclerosis, viral angiitis), pronounced spastic processes (migraine status), and endocrine diseases.

A separate type of cerebral ischemic stroke is perinatal stroke, which develops in the prenatal period due to progressive placental insufficiency, severe intrauterine infections affecting the cerebral vessels of the fetus and congenital heart and vascular pathology with intravascular thrombosis.

Features of the clinic of right-sided ischemic stroke in children

With the development of ischemic stroke of the right hemisphere in children, local (focal) neurological symptoms prevail over general cerebral symptoms. There is a high frequency of minor strokes - lacunar with the development of a clinical picture of an isolated motor variant (left-sided hemiparesis with paralysis of facial muscles on the left), ataxic ischemic stroke (with a predominance of symptoms of cerebellar lesion and moderate paresis of the extremities on the left), as well as hyperkinetic and aphatic variants of lacunar cerebral infarctions.

The hyperkinetic type of stroke is manifested by a combination of hemiballism and hemichorea, followed by the development of dystonic disorders several months after ischemic stroke (delayed dystonia). The aphatic variant develops with a lacunar stroke in the area of ​​the speech center and is manifested by speech disorders in left-handers (whose speech center is located in the right hemisphere of the brain). Also, additional symptoms of right-sided ischemic strokes in childhood is a subfebrile condition of an unclear etiology or an increase in body temperature to high numbers with extensive strokes. For the first time, quite often acute cerebrovascular accident occurs with symptoms of subclinical encephalomyopathy, but the regression of neurological deficit after ischemic stroke in children occurs much faster, which is associated with good neuroplasticity of brain cells.

Pushkareva Daria Sergeevna

Neurologist, site editor

The topic of strokes has recently become more than relevant. According to statistics, every 90 seconds, one of the residents of Russia has a stroke with different anatomical localizations and, as a result, different physiological consequences and predictions. There is a dependence of the incidence of the disease on race, nature of work (mental or physical), age and lifestyle. Today, stroke is the second leading cause of death according to the WHO. The first place belongs to ischemic heart disease (by the way, also a vascular disease). The third in a row are oncological diseases.

Strokes are the scourge of modern society

What is a stroke?

A stroke is a severe blockage of the blood circulation in the brain. There can be several mechanisms for the development of such a condition: blockage or compression of the vessel, or rupture of the vessel with the ensuing consequences.

If there is a violation of the integrity of the vessel, then it is implied hemorrhagic stroke... When the blood flow in the vessels of the brain is disturbed due to a thrombus or compression (for example, a tumor or hematoma), then the diagnosis sounds like an ischemic stroke. The mechanism of development of the disease is very similar to a heart attack (most often, vascular thrombosis is the cause of both a stroke and a heart attack). Only in the first case, everything happens in the vessels of the brain, and in the second - in the coronary arteries (vessels of the heart). We can say that a stroke is a cerebral infarction, in which there is also a site of necrosis due to impaired metabolism of substances and hypoxia of surrounding tissues.

It is known that one of the most important tasks of blood is the delivery of oxygen to organs and tissues. During a stroke, blood suddenly stops flowing into the brain tissue, due to a lack of oxygen, large areas of nerve cells suffer, which die with corresponding consequences for the patient.

In order to understand the seriousness of the condition and the mechanism of the process taking place, you need to know that each part of the brain is responsible for a specific function (s). Depending on the location and volume of the damaged tissue, the performance of one or another function suffers.

Risk factors

Some risk factors cannot be influenced (race, gender, heredity, age, season, climate).

It is quite possible to adjust other risk factors to prevent the possibility of stroke and its consequences. For example, hypodynamia, obesity, stressful situations, arterial hypertension, lipid metabolism disorders, diabetes mellitus, alcohol consumption and smoking.

Symptoms

It is also known from biology lessons at school that a person has two hemispheres of the brain: the left and right hemispheres. In this case, the left side of the brain controls the right side of the body, and vice versa. That is, if the patient has paresis of the left upper limb, for example, then the lesion is in the right side of the brain.

How to recognize a stroke?

Symptoms or consequences can be divided into general ones for strokes, regardless of the cause (blockage, compression or rupture), localization (right or left) and focal (characteristic of damage to a particular area of ​​the brain). It is also possible that there is an extensive stroke (most of the brain is damaged) or focal (a small part of the brain). Common symptoms include sudden headache, dizziness, nausea, tinnitus, loss of consciousness, tachycardia, sweating, fever, depression.

Characteristic feature, and at the same time, the problem for recognizing a stroke in the right hemisphere is the absence of speech impairments (in contrast to the symptoms of damage to the left hemisphere of the brain).

Therefore, with a right-sided stroke with mild symptoms, they rarely seek medical help in the early days of the disease, when you can significantly affect the outcome of the disease, preventing the consequences.

It must be said that the picture of such a state is not joyful, since the recovery period is complicated by neuropsychopathological syndromes that usually occur in the patient. Full restoration of lost functions is possible with minor lesions in the right hemisphere of the brain.

In case of extensive stroke after treatment, a successful prognosis is given if the patient can self-serve. As a rule, the consequences of such a stroke are disability, although there are exceptions to any rule.

With the localization of an extensive stroke in the right hemisphere, spatial disorientation occurs, the ability to objectively assess the shape and size of objects (including one's own body in space and time) is lost. The patient's left visual field disappears, that is, what healthy people see with lateral vision (left), the patient with a right-sided stroke does not see. Focal symptoms of right-sided stroke are considered paresis or paralysis of the extremities on the left; amnesia for recent events, drooping down the left corner of the mouth; spatial disorientation. In left-handed people, the consequences of a stroke can be impaired speech function.

Facial distortion in stroke

Suffers emotional sphere, behavior changes: it becomes inappropriate, inadequate, swagger appears, tact and correctness are absent. The difficulty in treatment and the likelihood of no effect when the right hemisphere is interested is very high, since patients are not aware of their condition, do not understand the danger and are not in the mood for recovery. Patients have no perception of reality. Such patients do not understand that they have problems with the ability to move, there may even be a feeling that there are many limbs, not two, so treatment can be very problematic.

Nevertheless, right-handed strokes in right-handers have a more favorable prognosis for the restoration of motor and cognitive functions, in contrast to damage to the left hemisphere, which is associated with significant speech and intellectual-mnestic disorders.

Treatment and rehabilitation

In these difficult periods, support and understanding of family and friends will be required.

On the part of doctors, it is necessary to stop the acute condition. At the same time, it is necessary to influence all possible links of pathogenesis. Therefore, antiplatelet agents, anticoagulants, enzymes and neuroprotective agents are necessarily included in the treatment regimen. Treatment should take place in a hospital under the supervision of a physician. The prognosis depends on the localization of the lesion focus - in the right or left hemispheres, the extent of the process, concomitant diseases, the patient's focus on recovery and the severity of the consequences.

A set of special exercises is selected individually for each patient

Rehabilitation measures should be comprehensive. The earlier treatment and rehabilitation is started, the more chances there are to return the patient to a decent quality of life and to prevent the consequences. At the same time, medications are continued, exercise therapy, massage, physiotherapy are prescribed.

Doctors' forecasts for a massive stroke of any localization are disappointing, you need to be prepared for serious consequences, the likelihood of a coma cannot be ruled out either. But the chances of survival are huge with the right treatment and care.

Prevention

Stroke prevention consists in controlling and correcting factors that can provoke a vascular catastrophe. With arterial hypertension, it is mandatory to take medications that maintain blood pressure at the required level. It is necessary to exclude bad habits, stressful situations. From drug support, it is possible to use antiplatelet agents - drugs that thin the blood; as well as cerebroprotectors and drugs that improve microcirculation. It is important to lead an active lifestyle, while controlling psycho-emotional stress.

Comprehensive stroke prevention

Ischemic stroke is not an independent, suddenly emerging condition, but a consequence of some process, therefore, the key to the success of prevention is the timely detection and prevention of such consequences and processes.

9.1. Violation of perceptual functions with damage to the left and right hemispheres of the brain and with damage to the median structures

In the aforementioned examination of 6-16-year-old children conducted by E.G. Simernitskaya (see Chapter 8), along with an analysis of speech disorders in the same children, a study of the state of perceptual processes in lesions of the left and right hemispheres of the brain and in lesions of the median structures.

It was shown that with injuries of the left hemisphere, the most pronounced disturbances of visual gnosis are observed in the perception of crossed out and superimposed images (Poppelreiter's figures). Lesions of the right hemisphere were accompanied by equally pronounced difficulties in visual perception of realistic images and figures of Poppelreiter. The defeat of the median structures (diencephalic-hypothalamic region) led to great difficulties in the perception of realistic images.

9.1.1. Violation of perceptual functions with damage to the left hemisphere of the brain

Disturbances in visual perception with lesions of the left hemisphere have a low frequency.

The maximum frequency of violations (in 29% of cases) was observed when recognizing object images and was associated with lesions of the occipital region of the left hemisphere.

These violations occurred when it was necessary to identify and correlate several leading features of an object. Children did not rely on the entire set of features in the perception of the image - they singled out one and based on it they made guesses. For example, a telephone was recognized as a clock, a table lamp was recognized as a mushroom.

The most pronounced impairments to object visual gnosis occurred during the perception of crossed out and superimposed images. They manifested themselves in the difficulties of separating the figure from the background, as a result of which only individual elements of the image were correctly assessed. For example, a hammer was recognized as a stick, a lily of the valley — twigs and leaves, a butterfly — a bat.

In visual-constructive activity (drawing), mild violations were also observed. In young children, they were not detected at all, even with damage to the parietal region. With age (after 10 years), the severity of pattern disturbances became more and more high.

In older children, the drawings were of a primitive, simplified nature. Spatial errors were also recorded when drawing volumetric figures.

With the lesion of the left hemisphere, it was characteristic to preserve the graphic image, which was usually reproduced correctly.

In general, the disturbance of the pattern was more often observed with lesions of the parietal region.

In older children school age with lesions of the left hemisphere, violations of visual-spatial functions were observed (in tests for spatial praxis, copying with inversion, in tests for a watch and a map, etc.).

However, the frequency of their occurrence was low and when they were detected, the nature of these disorders corresponded to those disorders that occur in adults. These disorders, as in adults, were associated with projective or coordinate representations.

It can be assumed that the low frequency of manifestations of disturbances in the perceptual sphere in lesions of the left hemisphere is of the same nature as the low frequency speech disorders... The left hemibular components of perceptual activity, which are associated with speech mediation of perceptual processes, are not yet sufficiently formed, which is due to the ongoing formation of the speech system.

9.1.2. Violation of perceptual functions with damage to the right hemisphere of the brain

Early lesions of the right hemisphere, manifested in the first year of life, lead to gross underdevelopment of those functions for which the right hemisphere is dominant (visual-spatial perception, visual-constructive and other types of perceptual activity).

With the defeat of the right hemisphere in children, violations of perceptual processes are manifested, as a rule, selectively. Often they arise only in the realm of facial gnosis. The sick do not recognize their own

5-58 relatives, and in less severe cases complain about bad memory on the face. As in adults, these disorders occurred when the right occipital region was affected.

As with the lesion of the left, in children with lesions of the right hemisphere, a violation of object gnosis was observed, but it was of a different nature. In this case, the errors were reversed: the mushroom was recognized as a table lamp, and the clock was recognized as a telephone. This indicates the different nature of these violations. With the defeat of the left hemisphere, due to the deficit of the process of sequential analysis of all signs of the object, details of the drawing, it is characteristic to ignore individual image elements - the telephone receiver, wires. In the case of damage to the right hemisphere, the difficulties in perceiving the perceived object are compensated by the analysis of possible variants of the image (what could it be?) And, on the basis of a guess, the object is, as it were, supplemented with “missing details”. Therefore, when the right hemisphere is affected, errors are very diverse: for example, a ball is recognized as a tomato, omelet, watermelon, etc., a coat is like a house without a window, a glass is like a washing machine.

Disorders of objective gnosis with lesions of the right hemisphere occurred more often than with lesions of the left hemisphere.

The same violations were found in the perception of crossed out figures (Poppelreiter). But if with a lesion of the left hemisphere, difficulties in this task manifested themselves more pronounced (to a greater extent than with the perception of objects actually depicted), then with any lesions of the right hemisphere there were no differences in the perception of figures upon presentation of each of these two tests. Errors in this case were also of a different nature. When the left hemisphere was affected, each individual fragment of the image was perceived adequately, but its correlation with other signs was disrupted, and this led to recognition based on an incomplete set of signs. In the case of damage to the right hemisphere, on the contrary, difficulties in perceiving individual fragments were compensated by the emergence of side, random semantic connections that were not oriented towards the leading sign: jug - bread; a butterfly — a ribbon, a pear, a turnip, etc. This led to recognition focused on a redundant set of features that went beyond the image.

Thus, impairments to object perception in the case of damage to the right and left hemispheres were of a qualitatively different nature, due to the specificity of information processing mechanisms in the left and right hemispheres - successive and simultaneous, respectively.

Lesions of the right hemisphere were also clearly manifested in the phenomenon of "left-sided inattention" - ignoring the stimuli located in the left half of the visual field. This violation could manifest itself in the form of ignoring all the stimuli located in the left half of the visual field, in other cases, the whole image disintegrated, and the conclusion about it was based only on the signs located on the right. Most often, only the leftmost elements were ignored.

Color perception disorders were recorded in isolated cases.

There were no violations of animal recognition (in the presence of facial agnosia).

Disturbances in perceptual processes with lesions of the right hemisphere were clearly manifested in the sphere of spatial representations, manifesting themselves in difficulties in spatial orientation.

In visual-constructive activity, during the execution of drawings, violations often had the character of a gross defect, which was never observed in lesions of the left hemisphere.

This was most clearly manifested when drawing volumetric figures. Often there was a disintegration not only of spatial representations, but also of visual images in general.

A distinctive feature of right hemispheric disorders (as opposed to left hemisphere) was that these disorders were not compensated for by copying.

Disturbance of the pattern occurred in 47% of cases and was most pronounced when the right parietal region was affected.

When the right hemisphere is damaged, there are violations of the topological ideas about the object (which does not happen with the defeat of the left hemisphere), as well as a violation of the ideas about the movement and transformation of the object.

At the same time, a comparison of the violation of spatial representations in children and adults reveals some differences. They are manifested in the fact that in childhood the right hemisphere provides a wider range of spatial representations than in adults. For example, with damage to the right hemisphere in children, both projective ideas and ideas about the coordinate system suffer (in adults, such violations are noted only with damage to the left hemisphere). In children, similar disorders occur equally with the defeat of both the left and right hemispheres.

In general, we can talk about the leading role of the right hemisphere in perceptual processes, which manifests itself already in childhood.

The absence of special differences in these disorders in children of primary and senior school age indicates that the dominance of the right hemisphere in perceptual processes occurs early.

9.1.3. Violation of perceptual processes with damage to the median structures

As noted above, damage to the hypothalamic-diencephalic region of the brain has traditionally been associated with a violation of upward activating influences, which led to changes in the normal functioning of the cortex.

Neuropsychological studies have shown that suffering in this area of ​​the brain leads not only to disturbances in the verbal nonsthetic sphere (pathological inhibition of traces by interfering influences, which were described above), but also to disturbances in the perceptual sphere.

In the first place here are the violations of objective gnosis, which are especially pronounced in the perception of realistic images. This is the qualitative difference between the symptoms of disorders of this area from the symptoms characteristic of lesions of the left hemisphere (in this case, the perception of Poppelreiter's figures suffers more than the perception of realistic images), and from the symptoms of damage to the right hemisphere (in this case, the perception of realistic and schematic images suffers approximately the same ).

As in the case of impaired auditory speech memory, perceptual impairments were more common in intracerebral lesions (in the region of the 3rd ventricle) than in extracerebral tumors.

The frequency and severity of disturbances in the perceptual sphere with lesions of the hypothalamic-diencephalic region significantly exceed the same disorders with damage to the left hemisphere and practically do not differ from the right hemisphere lesions.

Most often, these disorders occurred before the age of 10 years, to a lesser extent after 10 years.

A distinctive feature of visual impairments was that they were most clearly manifested in the perception of images of "living" objects (in particular, animals). In general, in childhood, violations of recognition of animal images are found independently of object and facial agnosia. This may indicate that these perceptions of these objects have a different brain organization.

For example, mistakes were typical when: a dog is recognized as a horse, a cow; a hare - like a kitten, a cat; chicken is like fish; the frog is like an owl. Such errors are extremely rare in hemispheric disorders, as a rule, only in those cases when the pathological process in the hemispheres also affected the median structures.

Another important symptom is a violation of color gnosis (17.7% of cases).

Often, coloring does not make it easier, but rather complicates the process of object identification. For example, orange orange is recognized as watermelon, cabbage; green watermelon - like an orange, a tomato.

The presentation of flowers outside the object increases the difficulty of identifying them. The largest number of errors in the perception of green, which was perceived as red, brown, yellow, gray, black. There were many mistakes in the perception of red, pink, orange colors.

It was characteristic that the errors could vary both in different patients and in one patient with repeated presentation of stimuli.

Violation of color gnosis was found mainly when naming colors, while the choice of a given color was available. When classifying color objects, errors occurred in distinguishing between red and green stimuli, attempts to place them in one group.

As noted by E.G. Simernitskaya, the revealed violations of color gnosis do not fit into the picture of congenital color anomalies, which are accompanied by a certain type of error. The variability of errors, the absence of aphasia for colors, the isolated manifestation of this disorder indicate that the violation of color perception in children with damage to the median structures has a different structure than that described in adults with damage to the left or right hemisphere.

In its manifestations, this disorder is most similar to the symptom of "anomie", which is part of the "split brain" syndrome, when interhemispheric interaction between structures that perceive visual information and which provide its speech designation is disrupted. This usually occurs when the posterior parts of the corpus callosum are cut or damaged, that is, when the interhemispheric connections are disturbed. But damage to the hypothalamic-diencephalic region does not lead to violations of the corpus callosum. Only the anterior commissure, which plays important role in interhemispheric transfer in animals.

It can be assumed that at the early stages of ontogeny, it is the anterior commissure that performs the function of such a transfer. E. G. Simernitskaya (1985) gives examples that may support this hypothesis.

In the first case, patient S. 12 years old was operated on for a tumor of the third ventricle affecting the optic nerves and chiasm. He had a sharp decrease in vision in his left eye, as well as bitemporal hemianopsia. This led to the fact that the perception remained only from the left half of the visual field in the right eye, from where information is transmitted, respectively, to the right hemisphere. Diagram of violations in the processing of visual information resulting from organic brain damage in patient S.

2. Occipital Neuropsychological Syndromes

The occipital region of the cerebral hemispheres provides, as is known, the processes of visual perception. In this case, the actual visual perceptual activity (visual gnosis) is provided by the work of the secondary parts of the visual analyzer in their relationship with the parietal structures. With the defeat of the occipital-parietal parts of the brain (both the left and right hemispheres), various disorders of visual-perceptual activity occur, primarily in the form of visual agnosias. Recently, data have been obtained on the role of the medial regions of the occipital regions of the brain in the processes of visual perception, since the latter can be disturbed when the pathological process is localized on the medial surface of the occipital regions of the brain. It should be noted that the diversity of the described variants of disturbance of visual-perceptual activity is determined by the partial nature of its defect in relation to various types of visual material (real objects, their images, colors, alphabetic and digital symbols, faces of familiar people, etc.) and various levels of visualization. perception as a complex purposeful activity based on the actualization of the past experience formed in ontogenesis (actualization of visual representations, holistic complex simultaneous perception of visual stimuli, the possibility of conscious identification of visually presented objects, the establishment of intramodal connections between various characteristics of information coming to the visual analyzer and intermodal connections, necessary to categorize visual stimuli at speech and thought levels). Behind the variety of manifestations of visual-perceptual disorders, undoubtedly, there are various brain factors providing this modality of reflection, which is leading in the structure of human mental activity, the analysis and psychological qualification of which is still carried out at the level of describing clinical and psychological phenomena. The reason for this empirical approach is the lack of a unified theory that summarizes the structural and dynamic characteristics of visual perception and takes into account the complex multi-level structure of this function, including its cerebral structural and functional organization. Violation of the sensory components of visual function does not lead, as a rule, to disorders of visual perception itself, to defects in the objective reflection of the external environment. Even with significant impairments in visual acuity, even with a sharp narrowing of the visual fields (up to the formation of a "tubular" visual field), visual perception does not lose its object-relatedness, although its speed characteristics may deteriorate, since additional time is needed to adjust the visual system to the performance of the perceptual task ... In these cases, we can talk about high compensatory capabilities of the visual system, which provide orientation in the objective world with a pronounced deficit of sensory support. The only exception is unilateral visual-spatial agnosia (OPA), which occurs with lesions of the deep or convexital parts of the right hemisphere of the brain, which has such naming equivalents as fixed left-sided homonymous hemianopsia or left-sided visual neglect syndrome. In the most pronounced forms of the development of this pathology, a systemic defect is found in the form of "non-perception" of those components of visual stimulation that enter the left visual field. This can be seen when the patient works with object images, when sketching objects and even in the patient's independent drawing, that is, when updating visual representations. The visible world and its image seem to split into two halves: reflected (right visual field) and non-reflective (left), which significantly distorts the process of visual perception. Ignoring the left half of the visual field can be detected not only when perceiving and copying object images, but also in such activities as drawing independently, evaluating the time on the clock, and even reading text, in which only the part "visible" by the right visual field is perceived. The distortion of the content of the text, the absurdity that arises in this case does not affect the patient's visual activity, which is carried out formally, without attempts to correct it. To what has been said about OPA, three provisions should be added that are important in the diagnostic aspect. Firstly, OPA can also occur in the absence of data on hemianopsia. In these cases, its manifestations are observed both in expanded form and in the form of a "tendency" to visual disregard, which results in such changes in visual gnosis as text displacement when writing in right side relative to the edge of the sheet of paper; enumeration of the objects depicted in the album not from left to right, but in the opposite direction; omission of individual words of the left edge of the text (with correction in case of their substantive significance), etc. It is characteristic that such symptoms can be observed with a lesion that is wider than only the posterior parts of the right hemisphere, zones, including the localization of the pathological process in the frontal region. Secondly, in some cases, AKI can also occur with damage to the left hemisphere of the brain in combination with other symptoms indicating subdominant features of the left hemisphere in this patient. Thirdly, OPA often acts as a polymodal syndrome, manifesting itself in perceptual ignoring not only the left visual field, but also the motor, tactile, and auditory spheres, i.e., affecting the perception of all stimuli entering the analytic systems of the right hemisphere of the brain, and relating to the left, relative to the scheme of the subject's own body, half of the space. The very name of this phenomenon - "one-sided spatial agnosia" - emphasizes its systemic nature, the involvement of the phenomenon in the pathology of various modalities and, which is very important, its complex structure, the formation of which is based on a spatial radical. In this sense, OPA in the series of visual agnosias occupies a special place as a particular manifestation of a more complex (possibly, in terms of the level of integration of spatial functions) syndrome. Why do clinicians and psychologists often talk about ASO in connection with the visual system? This is largely due to the availability of clinical and experimental vision of this phenomenon in visual-perceptual tests. However, it can be easily detected in the tactile sphere (ignoring the stimulus - touching the left hand while simultaneously touching the right), in the motor (ignoring the left hand in two-handed tests) and auditory (ignoring the stimuli presented to the left ear in the dichotic listening technique). The OPA is also found in the patient's behavior; the patient does not use his left hand, "forgets" to put slippers on his left leg, stumbles upon objects located on the left, while moving in space, etc. The mechanisms of the formation of this phenomenon are still unclear. Attempts to attribute it to attention disorders, in our opinion, are unproductive. More interesting, albeit rather schematic, may be the explanation of this clinical phenomenon in terms of "psychological protection" and a distorted internal picture of the disease. Moreover, ASA is almost always combined with anosognosia. In addition, in recent years, the idea of ​​\ u200b \ u200bthe relationship of the right hemisphere to individual-semantic formations in the structure of the personality has been developing. The latter circumstance may be the reason for the distortion of the internal picture of the disease in its sensory and personality-evaluative components when the right hemisphere is damaged. Other types of visual agnosias represent independent diagnostic value in neuropsychological practice: objective, simultaneous, facial, symbolic and color. Object agnosia occurs when the "wide zone" of the visual analyzer is affected and can be characterized either as the absence of the recognition process, or as a violation of the integrity of the perception of the object with the possible identification of its individual features or parts. The impossibility of visual identification of an object externally can manifest itself as a listing of individual fragments of an object or its image (fragmentation), and the isolation of only individual features of an object that are insufficient for its complete identification. Examples corresponding to these two levels of manifestation of subject agnosia will be: recognition of the image of "glasses" as a "bicycle", since there are two circles united by crossbeams; identification of a "key" as a "knife" or "spoon", based on the distinguished features "metal" and "long". In both cases, as A.R. Luria points out, the structure of the act of visual perception is incomplete; it does not rely on the entire set of features necessary and sufficient for visual identification of an object. For our part, we would like to note not only the incompleteness (fragmentation) of visual perception, but also the distortion of the very act of visual perception in comparison with the norm, where object recognition is carried out simultaneously, simultaneously. The expanded, "reasoning" form of visual perception, which it acquires in the syndrome described here, in healthy people can be seen only in the complicated conditions of identifying unfamiliar objects, that is, objects whose image is absent in the individual memory of a person. It cannot be ruled out that one of the mechanisms of subject agnosia may be a violation of the mnestic level of the visual analyzer, which prevents the comparison of the present stimulus with its equivalent in memory. Subject agnosia can have varying degrees of severity - from maximum (agnosia of real objects) to minimum (difficulty in recognizing contour images in noisy conditions or when superimposed on each other). As a rule, the presence of extensive subject agnosia indicates bilateral lesions of the occipital systems. With unilateral lesions of the occipital parts of the brain, differences in the structure of visual object agnosia can be seen. The defeat of the left hemisphere is manifested to a greater extent by a violation of the perception of objects by the type of enumeration of individual details, while the pathological process in the right hemisphere leads to the actual absence of an act of identification. It is interesting that in this case the patient can evaluate the visually presented object according to its significant characteristics, answering the researcher's questions about the attitude of the given object to "living - inanimate", "dangerous - not dangerous", "warm - cold", "large - small", " naked - fluffy ", etc. Differential and diagnostic signs of right-hemispheric object agnosia are the slowing down of the process of object identification, as well as a more accurate assessment of schematic images by the patient in comparison with realistic ones, and a narrowing of the volume of visual perception, a particular and more crude manifestation of which is simultaneous agnosia , allocated as an independent violation of visual perception. Before proceeding to the description of this form of visual disturbances, we note that in the case of unilateral lesion of the "wide visual zone", one can see a modal-specific violation of the voluntary memorization of the sequence of graphic stimuli, which manifests itself in a narrowing of the volume of reproduction in case of damage to the left hemisphere and is most clearly manifested when interfering task. A modal-specific mnestic defect in the visual sphere with damage to the right hemisphere is found in the difficulties of reproducing the order of the elements included in the memorized sequence of graphic material. Simultaneous agnosia occurs with bilateral or right-sided lesions of the occipito-parietal regions of the brain. The essence of this phenomenon in its extreme expression is the impossibility of simultaneous perception of several visual objects or a situation in a complex. Only one object is perceived, more precisely, only one operational unit of visual information is processed, which is currently the object of the patient's attention. For example, in the task "to put a point in the center of the circle", the patient's inconsistency is revealed, since it requires simultaneous perception in the relationship of three objects: the outline of the circle, the center of its area and the tip of a pencil. The patient "sees" only one of them. Simultaneous agnosia is not always so pronounced. In a number of cases, only difficulties are observed in the simultaneous perception of a complex of elements with the loss of any details or fragments. These difficulties can manifest themselves when reading, sketching or drawing on your own. Often, simultaneous agnosia is accompanied by impaired eye movements (gaze ataxia). Unilateral damage to the left occipital-parietal region can lead to impaired perception of symbols characteristic of the language systems familiar to the patient. The ability to identify letters and numbers is violated while their spelling is preserved (symbolic agnosia). It should be noted that in pure form alphanumeric agnosia is rare. Usually, with a wider lesion with the "capture" of the parietal structures proper with their function of spatial analysis and synthesis, not only perception, but also the writing and writing off of graphemes is disturbed. However, it is important that this symptom has a left-brain localization. Agnosia on the face, on the contrary, manifests itself with damage to the right hemisphere of the brain (middle and posterior parts of it). This is a selective gnostic defect and can occur in the absence of object and other agnosias. The degree of its severity is different: from impaired memorization of faces in special experimental tasks, through not recognizing familiar faces or their images (photographs) to not recognizing oneself in the mirror. In addition, a selective violation of either facial gnosis proper or memorization of faces is possible. What is the specificity of a "face" as a visual object in comparison with an object? It seems to us that the perception of a face, firstly, is determined by very subtle differentiations of an integral object ("face with an obscure expression") with the similarity of the main features (2 eyes, mouth, nose, forehead, etc.), which are usually not subject to analysis. if everything is in order in the face. Interpretation of impaired facial gnosis due to the deficit of the integral perception of the object is confirmed by the data on the difficulties of playing chess in patients with lesions of the right hemisphere. chess board in general, which leads to the disorganization of this activity. Secondly, the perception of a face always contains the contribution of the individuality of the perceiver, who sees in the face something of his own, subjective, even if these are portraits famous people... The specificity of the perceived egg both in its unique integrity, reflecting the individuality of the "sample", and in the relation of the perceiver to the original. Above we have already spoken about the role of the right hemisphere in direct, sensory processes, about its “semantic” function. At least for these reasons, the breakdown of the function of perception of faces becomes understandable when it is the right hemisphere of the brain that is affected. The least studied form of visual impairment is color agnosia. However, to date, some data have been obtained on color perception disorders in lesions of the right hemisphere of the brain. They are manifested by difficulties in differentiating mixed colors (brown, purple, orange, pastel colors). In addition, a violation of color recognition in a real object can be noted in comparison with the preservation of color recognition shown on separate cards. In conclusion of the description of visual impairment syndromes, it should be said that, despite their rather subtle analysis in the clinical neuropsychological aspect, in this area there are enough "blank spots" various disorders of visual-perceptual activity.