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. 1994 May;57(5):597–604. doi: 10.1136/jnnp.57.5.597

Residual rightward attentional bias after apparent recovery from right hemisphere damage: implications for a multicomponent model of neglect.

J B Mattingley 1, J L Bradshaw 1, J A Bradshaw 1, N C Nettleton 1
PMCID: PMC1072923  PMID: 8201332

Abstract

Unilateral neglect may be a multicomponent attentional disorder consisting of an initial automatic orienting of attention toward the ipsilesional side and a subsequent impairment in contralesionally reorienting attention, both of which are superimposed on a generalised reduction in attention resources. It has been hypothesised that patients' ability to reorient attention contralesionally may recover relatively quickly, but that the ipsilesional attention bias may be relatively persistent. This hypothesis was tested by consecutively examining 13 patients who had had a right hemisphere stroke, and who had left unilateral neglect. They were examined once shortly after the stroke and again 12 months later, using a battery of standard clinical and experimental tasks. Patients initially showed a strong and consistent rightward attentional bias in addition to a failure to reorient their attention leftward. After 12 months patients continued to show an abnormal ipsilesional attentional bias, though most were now able to fully reorient their attention toward the contralesional side. These results suggest that restitution of the capacity to reorient attention contralesionally may underlie the apparent recovery from clinical signs of unilateral neglect. The presence of a residual ipsilesional attentional bias in most patients, however, may, at least in part, account for the poor functional outcomes in some apparently "recovered" patients.

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Selected References

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  1. Albert M. L. A simple test of visual neglect. Neurology. 1973 Jun;23(6):658–664. doi: 10.1212/wnl.23.6.658. [DOI] [PubMed] [Google Scholar]
  2. Binder J., Marshall R., Lazar R., Benjamin J., Mohr J. P. Distinct syndromes of hemineglect. Arch Neurol. 1992 Nov;49(11):1187–1194. doi: 10.1001/archneur.1992.00530350109026. [DOI] [PubMed] [Google Scholar]
  3. Campbell D. C., Oxbury J. M. Recovery from unilateral visuo-spatial neglect? Cortex. 1976 Dec;12(4):303–312. doi: 10.1016/s0010-9452(76)80034-2. [DOI] [PubMed] [Google Scholar]
  4. Colombo A., De Renzi E., Faglioni P. The occurrence of visual neglect in patients with unilateral cerebral disease. Cortex. 1976 Sep;12(3):221–231. doi: 10.1016/s0010-9452(76)80003-2. [DOI] [PubMed] [Google Scholar]
  5. Costa L. D., Vaughan G., Jr, Horwitz M., Ritter W. Patterns of behavioral deficit associated with visual spatial neglect. Cortex. 1969 Sep;5(3):242–263. doi: 10.1016/s0010-9452(69)80033-x. [DOI] [PubMed] [Google Scholar]
  6. D'Erme P., Robertson I., Bartolomeo P., Daniele A., Gainotti G. Early rightwards orienting of attention on simple reaction time performance in patients with left-sided neglect. Neuropsychologia. 1992 Nov;30(11):989–1000. doi: 10.1016/0028-3932(92)90050-v. [DOI] [PubMed] [Google Scholar]
  7. De Renzi E., Gentilini M., Faglioni P., Barbieri C. Attentional shift towards the rightmost stimuli in patients with left visual neglect. Cortex. 1989 Jun;25(2):231–237. doi: 10.1016/s0010-9452(89)80039-5. [DOI] [PubMed] [Google Scholar]
  8. FISHER M. Left hemiplegia and motor impresistence. J Nerv Ment Dis. 1956 Mar;123(3):201–218. doi: 10.1097/00005053-195603000-00001. [DOI] [PubMed] [Google Scholar]
  9. Gainotti G., D'Erme P., Bartolomeo P. Early orientation of attention toward the half space ipsilateral to the lesion in patients with unilateral brain damage. J Neurol Neurosurg Psychiatry. 1991 Dec;54(12):1082–1089. doi: 10.1136/jnnp.54.12.1082. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gainotti G., Messerli P., Tissot R. Qualitative analysis of unilateral spatial neglect in relation to laterality of cerebral lesions. J Neurol Neurosurg Psychiatry. 1972 Aug;35(4):545–550. doi: 10.1136/jnnp.35.4.545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gilbert C., Bakan P. Visual asymmetry in perception of faces. Neuropsychologia. 1973 Jul;11(3):355–362. doi: 10.1016/0028-3932(73)90049-3. [DOI] [PubMed] [Google Scholar]
  12. Halligan P. W., Burn J. P., Marshall J. C., Wade D. T. Visuo-spatial neglect: qualitative differences and laterality of cerebral lesion. J Neurol Neurosurg Psychiatry. 1992 Nov;55(11):1060–1068. doi: 10.1136/jnnp.55.11.1060. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Halligan P. W., Manning L., Marshall J. C. Hemispheric activation vs spatio-motor cueing in visual neglect: a case study. Neuropsychologia. 1991;29(2):165–176. doi: 10.1016/0028-3932(91)90018-4. [DOI] [PubMed] [Google Scholar]
  14. Halligan P. W., Marshall J. C. Left visuo-spatial neglect: a meaningless entity? Cortex. 1992 Dec;28(4):525–535. doi: 10.1016/s0010-9452(13)80225-0. [DOI] [PubMed] [Google Scholar]
  15. Halligan P. W., Marshall J. C., Wade D. T. Visuospatial neglect: underlying factors and test sensitivity. Lancet. 1989 Oct 14;2(8668):908–911. doi: 10.1016/s0140-6736(89)91561-4. [DOI] [PubMed] [Google Scholar]
  16. Hier D. B., Mondlock J., Caplan L. R. Recovery of behavioral abnormalities after right hemisphere stroke. Neurology. 1983 Mar;33(3):345–350. doi: 10.1212/wnl.33.3.345. [DOI] [PubMed] [Google Scholar]
  17. Karnath H. O. Deficits of attention in acute and recovered visual hemi-neglect. Neuropsychologia. 1988;26(1):27–43. doi: 10.1016/0028-3932(88)90028-0. [DOI] [PubMed] [Google Scholar]
  18. Kinsella G., Olver J., Ng K., Packer S., Stark R. Analysis of the syndrome of unilateral neglect. Cortex. 1993 Mar;29(1):135–140. doi: 10.1016/s0010-9452(13)80217-1. [DOI] [PubMed] [Google Scholar]
  19. Levy J., Heller W., Banich M. T., Burton L. A. Asymmetry of perception in free viewing of chimeric faces. Brain Cogn. 1983 Oct;2(4):404–419. doi: 10.1016/0278-2626(83)90021-0. [DOI] [PubMed] [Google Scholar]
  20. Luh K. E., Rueckert L. M., Levy J. Perceptual asymmetries for free viewing of several types of chimeric stimuli. Brain Cogn. 1991 May;16(1):83–103. doi: 10.1016/0278-2626(91)90087-o. [DOI] [PubMed] [Google Scholar]
  21. Làdavas E. Selective spatial attention in patients with visual extinction. Brain. 1990 Oct;113(Pt 5):1527–1538. doi: 10.1093/brain/113.5.1527. [DOI] [PubMed] [Google Scholar]
  22. MAHONEY F. I., BARTHEL D. W. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61–65. [PubMed] [Google Scholar]
  23. Mattingley J. B., Bradshaw J. L., Phillips J. G., Bradshaw J. A. Reversed perceptual asymmetry for faces in left unilateral neglect. Brain Cogn. 1993 Nov;23(2):145–165. doi: 10.1006/brcg.1993.1052. [DOI] [PubMed] [Google Scholar]
  24. Mattingley J. B., Pierson J. M., Bradshaw J. L., Phillips J. G., Bradshaw J. A. To see or not to see: the effects of visible and invisible cues on line bisection judgements in unilateral neglect. Neuropsychologia. 1993 Nov;31(11):1201–1215. doi: 10.1016/0028-3932(93)90068-b. [DOI] [PubMed] [Google Scholar]
  25. Mesulam M. M. A cortical network for directed attention and unilateral neglect. Ann Neurol. 1981 Oct;10(4):309–325. doi: 10.1002/ana.410100402. [DOI] [PubMed] [Google Scholar]
  26. Ogden J. A. Anterior-posterior interhemispheric differences in the loci of lesions producing visual hemineglect. Brain Cogn. 1985 Jan;4(1):59–75. doi: 10.1016/0278-2626(85)90054-5. [DOI] [PubMed] [Google Scholar]
  27. Oxbury J. M., Campbell D. C., Oxbury S. M. Unilateral spatial neglect and impairments of spatial analysis and visual perception. Brain. 1974 Sep;97(3):551–564. doi: 10.1093/brain/97.1.551. [DOI] [PubMed] [Google Scholar]
  28. Patterson K., Bradshaw J. L. Differential hemispheric mediation of nonverbal visual stimuli. J Exp Psychol Hum Percept Perform. 1975 Aug;1(3):246–252. doi: 10.1037//0096-1523.1.3.246. [DOI] [PubMed] [Google Scholar]
  29. Petersen S. E., Robinson D. L., Currie J. N. Influences of lesions of parietal cortex on visual spatial attention in humans. Exp Brain Res. 1989;76(2):267–280. doi: 10.1007/BF00247887. [DOI] [PubMed] [Google Scholar]
  30. Pizzamiglio L., Antonucci G., Judica A., Montenero P., Razzano C., Zoccolotti P. Cognitive rehabilitation of the hemineglect disorder in chronic patients with unilateral right brain damage. J Clin Exp Neuropsychol. 1992 Nov;14(6):901–923. doi: 10.1080/01688639208402543. [DOI] [PubMed] [Google Scholar]
  31. Pizzamiglio L., Zoccolotti P., Mammucari A., Cesaroni R. The independence of face identity and facial expression recognition mechanisms: relationship to sex and cognitive style. Brain Cogn. 1983 Apr;2(2):176–188. doi: 10.1016/0278-2626(83)90007-6. [DOI] [PubMed] [Google Scholar]
  32. Posner M. I., Petersen S. E. The attention system of the human brain. Annu Rev Neurosci. 1990;13:25–42. doi: 10.1146/annurev.ne.13.030190.000325. [DOI] [PubMed] [Google Scholar]
  33. Posner M. I., Walker J. A., Friedrich F. A., Rafal R. D. How do the parietal lobes direct covert attention? Neuropsychologia. 1987;25(1A):135–145. doi: 10.1016/0028-3932(87)90049-2. [DOI] [PubMed] [Google Scholar]
  34. Posner M. I., Walker J. A., Friedrich F. J., Rafal R. D. Effects of parietal injury on covert orienting of attention. J Neurosci. 1984 Jul;4(7):1863–1874. doi: 10.1523/JNEUROSCI.04-07-01863.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Riddoch M. J., Humphreys G. W. The effect of cueing on unilateral neglect. Neuropsychologia. 1983;21(6):589–599. doi: 10.1016/0028-3932(83)90056-8. [DOI] [PubMed] [Google Scholar]
  36. Robertson I. H. Digit span and visual neglect: a puzzling relationship. Neuropsychologia. 1990;28(2):217–222. doi: 10.1016/0028-3932(90)90103-u. [DOI] [PubMed] [Google Scholar]
  37. Robertson I. Anomalies in the laterality of omissions in unilateral left visual neglect: implications for an attentional theory of neglect. Neuropsychologia. 1989;27(2):157–165. doi: 10.1016/0028-3932(89)90168-1. [DOI] [PubMed] [Google Scholar]
  38. Robertson I., Frasca R. Attentional load and visual neglect. Int J Neurosci. 1992 Jan;62(1-2):45–56. doi: 10.3109/00207459108999756. [DOI] [PubMed] [Google Scholar]
  39. Schenkenberg T., Bradford D. C., Ajax E. T. Line bisection and unilateral visual neglect in patients with neurologic impairment. Neurology. 1980 May;30(5):509–517. doi: 10.1212/wnl.30.5.509. [DOI] [PubMed] [Google Scholar]
  40. Stone S. P., Patel P., Greenwood R. J., Halligan P. W. Measuring visual neglect in acute stroke and predicting its recovery: the visual neglect recovery index. J Neurol Neurosurg Psychiatry. 1992 Jun;55(6):431–436. doi: 10.1136/jnnp.55.6.431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Wade D. T., Wood V. A., Hewer R. L. Recovery of cognitive function soon after stroke: a study of visual neglect, attention span and verbal recall. J Neurol Neurosurg Psychiatry. 1988 Jan;51(1):10–13. doi: 10.1136/jnnp.51.1.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Zoccolotti P., Antonucci G., Judica A., Montenero P., Pizzamiglio L., Razzano C. Incidence and evolution of the hemineglect disorder in chronic patients with unilateral right brain damage. Int J Neurosci. 1989 Aug;47(3-4):209–216. doi: 10.3109/00207458908987435. [DOI] [PubMed] [Google Scholar]

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