Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2004 Oct;75(10):1401–1410. doi: 10.1136/jnnp.2002.003095

Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients

A Farne 1, L Buxbaum 1, M Ferraro 1, F Frassinetti 1, J Whyte 1, T Veramonti 1, V Angeli 1, H Coslett 1, E Ladavas 1
PMCID: PMC1738754  PMID: 15377685

Abstract

Objectives: The evolutionary pattern of spontaneous recovery from acute neglect was studied by assessing cognitive deficits and motor impairments. Detailed lesion reconstruction was also performed to correlate the presence of and recovery from neglect to neural substrates.

Methods: A consecutive series of right brain-damaged (RBD) patients with and without neglect underwent weekly tests in the acute phase of the illness. The battery assessed neglect deficits, neglect-related deficits, and motor impairment. Age-matched normal subjects were also investigated to ascertain the presence of non lateralised attentional deficits. Some neglect patients were also available for later investigation during the chronic phase of their illness.

Results: Partial recovery of neglect deficits was observed at the end of the acute period and during the chronic phase. Spatial attention was impaired in acute neglect patients, while non spatial attentional deficits were present in RBD patients with and without acute neglect. A strong association was found between acute neglect and fronto-parietal lesions. Similar lesions were associated with neglect persistence. In the chronic stage, neglect recovery was paralleled by improved motor control of the contralesional upper limb, thus emphasising that neglect is a negative prognostic factor in motor functional recovery.

Conclusions: These findings show that spatial attention deficits partially improve during the acute phase of the disease in less than half the patients investigated. There was an improvement in left visuospatial neglect at a later, chronic stage of the disease, but this recovery was not complete.

Full Text

The Full Text of this article is available as a PDF (326.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berti A., Frassinetti F. When far becomes near: remapping of space by tool use. J Cogn Neurosci. 2000 May;12(3):415–420. doi: 10.1162/089892900562237. [DOI] [PubMed] [Google Scholar]
  2. Bisiach E., Capitani E., Luzzatti C., Perani D. Brain and conscious representation of outside reality. Neuropsychologia. 1981;19(4):543–551. doi: 10.1016/0028-3932(81)90020-8. [DOI] [PubMed] [Google Scholar]
  3. Bisiach E., Geminiani G., Berti A., Rusconi M. L. Perceptual and premotor factors of unilateral neglect. Neurology. 1990 Aug;40(8):1278–1281. doi: 10.1212/wnl.40.8.1278. [DOI] [PubMed] [Google Scholar]
  4. Bisiach E., Perani D., Vallar G., Berti A. Unilateral neglect: personal and extra-personal. Neuropsychologia. 1986;24(6):759–767. doi: 10.1016/0028-3932(86)90075-8. [DOI] [PubMed] [Google Scholar]
  5. Buxbaum L. J., Ferraro M. K., Veramonti T., Farne A., Whyte J., Ladavas E., Frassinetti F., Coslett H. B. Hemispatial neglect: Subtypes, neuroanatomy, and disability. Neurology. 2004 Mar 9;62(5):749–756. doi: 10.1212/01.wnl.0000113730.73031.f4. [DOI] [PubMed] [Google Scholar]
  6. Buxbaum L. J., Permaul P. Hand-centered attentional and motor asymmetries in unilateral neglect. Neuropsychologia. 2001;39(7):653–664. doi: 10.1016/s0028-3932(01)00011-2. [DOI] [PubMed] [Google Scholar]
  7. Cherney L. R., Halper A. S. Unilateral visual neglect in right-hemisphere stroke: a longitudinal study. Brain Inj. 2001 Jul;15(7):585–592. doi: 10.1080/02699050010009090. [DOI] [PubMed] [Google Scholar]
  8. Cocchini G., Cubelli R., Della Sala S., Beschin N. Neglect without extinction. Cortex. 1999 Jun;35(3):285–313. doi: 10.1016/s0010-9452(08)70802-5. [DOI] [PubMed] [Google Scholar]
  9. Coslett H. B., Bowers D., Fitzpatrick E., Haws B., Heilman K. M. Directional hypokinesia and hemispatial inattention in neglect. Brain. 1990 Apr;113(Pt 2):475–486. doi: 10.1093/brain/113.2.475. [DOI] [PubMed] [Google Scholar]
  10. Coslett H. B., Bowers D., Heilman K. M. Reduction in cerebral activation after right hemisphere stroke. Neurology. 1987 Jun;37(6):957–962. doi: 10.1212/wnl.37.6.957. [DOI] [PubMed] [Google Scholar]
  11. Cutting J. Study of anosognosia. J Neurol Neurosurg Psychiatry. 1978 Jun;41(6):548–555. doi: 10.1136/jnnp.41.6.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Denes G., Semenza C., Stoppa E., Lis A. Unilateral spatial neglect and recovery from hemiplegia: a follow-up study. Brain. 1982 Sep;105(Pt 3):543–552. doi: 10.1093/brain/105.3.543. [DOI] [PubMed] [Google Scholar]
  13. Diller L., Gordon W. A. Interventions for cognitive deficits in brain-injured adults. J Consult Clin Psychol. 1981 Dec;49(6):822–834. doi: 10.1037//0022-006x.49.6.822. [DOI] [PubMed] [Google Scholar]
  14. Egelko S., Gordon W. A., Hibbard M. R., Diller L., Lieberman A., Holliday R., Ragnarsson K., Shaver M. S., Orazem J. Relationship among CT scans, neurological exam, and neuropsychological test performance in right-brain-damaged stroke patients. J Clin Exp Neuropsychol. 1988 Oct;10(5):539–564. doi: 10.1080/01688638808402794. [DOI] [PubMed] [Google Scholar]
  15. Faglioni P., Scotti G., Spinnler H. The performance of brain-damaged patients in spatial localization of visual and tactile stimuli. Brain. 1971;94(3):443–454. doi: 10.1093/brain/94.3.443. [DOI] [PubMed] [Google Scholar]
  16. Ferro J. M., Kertesz A., Black S. E. Subcortical neglect: quantitation, anatomy, and recovery. Neurology. 1987 Sep;37(9):1487–1492. doi: 10.1212/wnl.37.9.1487. [DOI] [PubMed] [Google Scholar]
  17. Frassinetti F., Rossi M., Làdavas E. Passive limb movements improve visual neglect. Neuropsychologia. 2001;39(7):725–733. doi: 10.1016/s0028-3932(00)00156-1. [DOI] [PubMed] [Google Scholar]
  18. Gainotti G., D'Erme P., Monteleone D., Silveri M. C. Mechanisms of unilateral spatial neglect in relation to laterality of cerebral lesions. Brain. 1986 Aug;109(Pt 4):599–612. doi: 10.1093/brain/109.4.599. [DOI] [PubMed] [Google Scholar]
  19. Girotti F., Casazza M., Musicco M., Avanzini G. Oculomotor disorders in cortical lesions in man: the role of unilateral neglect. Neuropsychologia. 1983;21(5):543–553. doi: 10.1016/0028-3932(83)90010-6. [DOI] [PubMed] [Google Scholar]
  20. Guariglia C., Antonucci G. Personal and extrapersonal space: a case of neglect dissociation. Neuropsychologia. 1992 Nov;30(11):1001–1009. doi: 10.1016/0028-3932(92)90051-m. [DOI] [PubMed] [Google Scholar]
  21. HECAEN H., PENFIELD W., BERTRAND C., MALMO R. The syndrome of apractognosia due to lesions of the minor cerebral hemisphere. AMA Arch Neurol Psychiatry. 1956 Apr;75(4):400–434. [PubMed] [Google Scholar]
  22. Halligan P. W., Marshall J. C. Left neglect for near but not far space in man. Nature. 1991 Apr 11;350(6318):498–500. doi: 10.1038/350498a0. [DOI] [PubMed] [Google Scholar]
  23. Halligan Peter W., Fink Gereon R., Marshall John C., Vallar Giuseppe. Spatial cognition: evidence from visual neglect. Trends Cogn Sci. 2003 Mar;7(3):125–133. doi: 10.1016/s1364-6613(03)00032-9. [DOI] [PubMed] [Google Scholar]
  24. Harvey M., Milner A. D., Roberts R. C. An investigation of hemispatial neglect using the Landmark Task. Brain Cogn. 1995 Feb;27(1):59–78. doi: 10.1006/brcg.1995.1004. [DOI] [PubMed] [Google Scholar]
  25. Harvey Monika, Krämer-McCaffery Tanja, Dow Lindsay, Murphy Peter J. S., Gilchrist Iain D. Categorisation of 'perceptual' and 'premotor' neglect patients across different tasks: is there strong evidence for a dichotomy? Neuropsychologia. 2002;40(8):1387–1395. doi: 10.1016/s0028-3932(01)00202-0. [DOI] [PubMed] [Google Scholar]
  26. Heilman K. M., Bowers D., Coslett H. B., Whelan H., Watson R. T. Directional hypokinesia: prolonged reaction times for leftward movements in patients with right hemisphere lesions and neglect. Neurology. 1985 Jun;35(6):855–859. doi: 10.1212/wnl.35.6.855. [DOI] [PubMed] [Google Scholar]
  27. Heilman K. M., Valenstein E. Frontal lobe neglect in man. Neurology. 1972 Jun;22(6):660–664. doi: 10.1212/wnl.22.6.660. [DOI] [PubMed] [Google Scholar]
  28. Heilman K. M., Valenstein E. Mechanisms underlying hemispatial neglect. Ann Neurol. 1979 Feb;5(2):166–170. doi: 10.1002/ana.410050210. [DOI] [PubMed] [Google Scholar]
  29. 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]
  30. Hillis A. E., Wityk R. J., Barker P. B., Beauchamp N. J., Gailloud P., Murphy K., Cooper O., Metter E. J. Subcortical aphasia and neglect in acute stroke: the role of cortical hypoperfusion. Brain. 2002 May;125(Pt 5):1094–1104. doi: 10.1093/brain/awf113. [DOI] [PubMed] [Google Scholar]
  31. Hjaltason H., Tegnér R., Tham K., Levander M., Ericson K. Sustained attention and awareness of disability in chronic neglect. Neuropsychologia. 1996 Dec;34(12):1229–1233. doi: 10.1016/0028-3932(96)00044-9. [DOI] [PubMed] [Google Scholar]
  32. Husain Masud, Rorden Chris. Non-spatially lateralized mechanisms in hemispatial neglect. Nat Rev Neurosci. 2003 Jan;4(1):26–36. doi: 10.1038/nrn1005. [DOI] [PubMed] [Google Scholar]
  33. Karnath H. O., Ferber S., Himmelbach M. Spatial awareness is a function of the temporal not the posterior parietal lobe. Nature. 2001 Jun 21;411(6840):950–953. doi: 10.1038/35082075. [DOI] [PubMed] [Google Scholar]
  34. Karnath Hans Otto, Himmelbach Marc, Rorden Chris. The subcortical anatomy of human spatial neglect: putamen, caudate nucleus and pulvinar. Brain. 2002 Feb;125(Pt 2):350–360. doi: 10.1093/brain/awf032. [DOI] [PubMed] [Google Scholar]
  35. Karnath Hans-Otto, Niemeier Matthias. Task-dependent differences in the exploratory behaviour of patients with spatial neglect. Neuropsychologia. 2002;40(9):1577–1585. doi: 10.1016/s0028-3932(02)00020-9. [DOI] [PubMed] [Google Scholar]
  36. Leibovitch F. S., Black S. E., Caldwell C. B., Ebert P. L., Ehrlich L. E., Szalai J. P. Brain-behavior correlations in hemispatial neglect using CT and SPECT: the Sunnybrook Stroke Study. Neurology. 1998 Apr;50(4):901–908. doi: 10.1212/wnl.50.4.901. [DOI] [PubMed] [Google Scholar]
  37. Leibovitch F. S., Black S. E., Caldwell C. B., McIntosh A. R., Ehrlich L. E., Szalai J. P. Brain SPECT imaging and left hemispatial neglect covaried using partial least squares: the Sunnybrook Stroke study. Hum Brain Mapp. 1999;7(4):244–253. doi: 10.1002/(SICI)1097-0193(1999)7:4<244::AID-HBM3>3.0.CO;2-K. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Làdavas E., Berti A., Ruozzi E., Barboni F. Neglect as a deficit determined by an imbalance between multiple spatial representations. Exp Brain Res. 1997 Oct;116(3):493–500. doi: 10.1007/pl00005777. [DOI] [PubMed] [Google Scholar]
  39. Làdavas E., Umiltà C., Ziani P., Brogi A., Minarini M. The role of right side objects in left side neglect: a dissociation between perceptual and directional motor neglect. Neuropsychologia. 1993 Aug;31(8):761–773. doi: 10.1016/0028-3932(93)90127-l. [DOI] [PubMed] [Google Scholar]
  40. Maguire Anne M., Ogden Jenni A. MRI brain scan analyses and neuropsychological profiles of nine patients with persisting unilateral neglect. Neuropsychologia. 2002;40(7):879–887. doi: 10.1016/s0028-3932(01)00169-5. [DOI] [PubMed] [Google Scholar]
  41. Matalon R., Michals K., Sebesta D., Deanching M., Gashkoff P., Casanova J. Aspartoacylase deficiency and N-acetylaspartic aciduria in patients with Canavan disease. Am J Med Genet. 1988 Feb;29(2):463–471. doi: 10.1002/ajmg.1320290234. [DOI] [PubMed] [Google Scholar]
  42. Mattingley J. B., Bradshaw J. L., Phillips J. G. Impairments of movement initiation and execution in unilateral neglect. Directional hypokinesia and bradykinesia. Brain. 1992 Dec;115(Pt 6):1849–1874. doi: 10.1093/brain/115.6.1849. [DOI] [PubMed] [Google Scholar]
  43. Mattingley J. B., Husain M., Rorden C., Kennard C., Driver J. Motor role of human inferior parietal lobe revealed in unilateral neglect patients. Nature. 1998 Mar 12;392(6672):179–182. doi: 10.1038/32413. [DOI] [PubMed] [Google Scholar]
  44. McDowell S., Whyte J., D'Esposito M. Working memory impairments in traumatic brain injury: evidence from a dual-task paradigm. Neuropsychologia. 1997 Oct;35(10):1341–1353. doi: 10.1016/s0028-3932(97)00082-1. [DOI] [PubMed] [Google Scholar]
  45. Milner A. D., Harvey M., Roberts R. C., Forster S. V. Line bisection errors in visual neglect: misguided action or size distortion? Neuropsychologia. 1993 Jan;31(1):39–49. doi: 10.1016/0028-3932(93)90079-f. [DOI] [PubMed] [Google Scholar]
  46. Mort Dominic J., Malhotra Paresh, Mannan Sabira K., Rorden Chris, Pambakian Alidz, Kennard Chris, Husain Masud. The anatomy of visual neglect. Brain. 2003 Jun 23;126(Pt 9):1986–1997. doi: 10.1093/brain/awg200. [DOI] [PubMed] [Google Scholar]
  47. Motomura N., Yamadori A., Mori E., Ogura J., Sakai T., Sawada T. Unilateral spatial neglect due to hemorrhage in the thalamic region. Acta Neurol Scand. 1986 Sep;74(3):190–194. doi: 10.1111/j.1600-0404.1986.tb07854.x. [DOI] [PubMed] [Google Scholar]
  48. Nico D. Detecting directional hypokinesia: the epidiascope technique. Neuropsychologia. 1996 May;34(5):471–474. doi: 10.1016/0028-3932(95)00123-9. [DOI] [PubMed] [Google Scholar]
  49. Nigg J. T., Swanson J. M., Hinshaw S. P. Covert visual spatial attention in boys with attention deficit hyperactivity disorder: lateral effects, methylphenidate response and results for parents. Neuropsychologia. 1997 Feb;35(2):165–176. doi: 10.1016/s0028-3932(96)00070-x. [DOI] [PubMed] [Google Scholar]
  50. 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]
  51. Pantano P., Formisano R., Ricci M., Di Piero V., Sabatini U., Di Pofi B., Rossi R., Bozzao L., Lenzi G. L. Motor recovery after stroke. Morphological and functional brain alterations. Brain. 1996 Dec;119(Pt 6):1849–1857. doi: 10.1093/brain/119.6.1849. [DOI] [PubMed] [Google Scholar]
  52. Robertson I. H. Do we need the "lateral" in unilateral neglect? Spatially nonselective attention deficits in unilateral neglect and their implications for rehabilitation. Neuroimage. 2001 Jul;14(1 Pt 2):S85–S90. doi: 10.1006/nimg.2001.0838. [DOI] [PubMed] [Google Scholar]
  53. Robertson I. H., Manly T., Andrade J., Baddeley B. T., Yiend J. 'Oops!': performance correlates of everyday attentional failures in traumatic brain injured and normal subjects. Neuropsychologia. 1997 Jun;35(6):747–758. doi: 10.1016/s0028-3932(97)00015-8. [DOI] [PubMed] [Google Scholar]
  54. Robertson I. H., Manly T., Beschin N., Daini R., Haeske-Dewick H., Hömberg V., Jehkonen M., Pizzamiglio G., Shiel A., Weber E. Auditory sustained attention is a marker of unilateral spatial neglect. Neuropsychologia. 1997 Dec;35(12):1527–1532. doi: 10.1016/s0028-3932(97)00084-5. [DOI] [PubMed] [Google Scholar]
  55. Robertson I. H., North N. Active and passive activation of left limbs: influence on visual and sensory neglect. Neuropsychologia. 1993 Mar;31(3):293–300. doi: 10.1016/0028-3932(93)90093-f. [DOI] [PubMed] [Google Scholar]
  56. 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]
  57. Samuelsson H., Hjelmquist E. K., Jensen C., Ekholm S., Blomstrand C. Nonlateralized attentional deficits: an important component behind persisting visuospatial neglect? J Clin Exp Neuropsychol. 1998 Feb;20(1):73–88. doi: 10.1076/jcen.20.1.73.1481. [DOI] [PubMed] [Google Scholar]
  58. Samuelsson H., Jensen C., Ekholm S., Naver H., Blomstrand C. Anatomical and neurological correlates of acute and chronic visuospatial neglect following right hemisphere stroke. Cortex. 1997 Jun;33(2):271–285. doi: 10.1016/s0010-9452(08)70004-2. [DOI] [PubMed] [Google Scholar]
  59. Schubert F., Spatt J. Double dissociations between neglect tests: possible relation to lesion site. Eur Neurol. 2001;45(3):160–164. doi: 10.1159/000052115. [DOI] [PubMed] [Google Scholar]
  60. Sterzi R., Bottini G., Celani M. G., Righetti E., Lamassa M., Ricci S., Vallar G. Hemianopia, hemianaesthesia, and hemiplegia after right and left hemisphere damage. A hemispheric difference. J Neurol Neurosurg Psychiatry. 1993 Mar;56(3):308–310. doi: 10.1136/jnnp.56.3.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. 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]
  62. Stone S. P., Patel P., Greenwood R. J. Selection of acute stroke patients for treatment of visual neglect. J Neurol Neurosurg Psychiatry. 1993 May;56(5):463–466. doi: 10.1136/jnnp.56.5.463. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Tegnér R., Levander M. Through a looking glass. A new technique to demonstrate directional hypokinesia in unilateral neglect. Brain. 1991 Aug;114(Pt 4):1943–1951. doi: 10.1093/brain/114.4.1943. [DOI] [PubMed] [Google Scholar]
  64. Vallar G., Perani D., Cappa S. F., Messa C., Lenzi G. L., Fazio F. Recovery from aphasia and neglect after subcortical stroke: neuropsychological and cerebral perfusion study. J Neurol Neurosurg Psychiatry. 1988 Oct;51(10):1269–1276. doi: 10.1136/jnnp.51.10.1269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Vallar G., Perani D. The anatomy of unilateral neglect after right-hemisphere stroke lesions. A clinical/CT-scan correlation study in man. Neuropsychologia. 1986;24(5):609–622. doi: 10.1016/0028-3932(86)90001-1. [DOI] [PubMed] [Google Scholar]
  66. Vilkki J. Hemi-inattention in visual search for parallel lines after focal cerebral lesions. J Clin Exp Neuropsychol. 1989 Mar;11(2):319–331. doi: 10.1080/01688638908400892. [DOI] [PubMed] [Google Scholar]
  67. Weiller C., Willmes K., Reiche W., Thron A., Isensee C., Buell U., Ringelstein E. B. The case of aphasia or neglect after striatocapsular infarction. Brain. 1993 Dec;116(Pt 6):1509–1525. doi: 10.1093/brain/116.6.1509. [DOI] [PubMed] [Google Scholar]
  68. Wilson B., Cockburn J., Halligan P. Development of a behavioral test of visuospatial neglect. Arch Phys Med Rehabil. 1987 Feb;68(2):98–102. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES