Eastchester clapping sign

A 63-year-old right-handed man with known right carotid artery occlusion developed acute left arm weakness. When asked to clap his hands, he brought the right hand to midline and stopped (figure, A; video). A CT scan demonstrated a right frontal infarction (figure, B, arrow).

Patient photograph and head CT

Figure. (A) When this patient with left arm weakness and hemispatial neglect was asked to clap hands, the right hand stopped at the midline. (B) Noncontrast head CT demonstrates a right frontal hypodensity consistent with ischemic stroke.

The Eastchester clapping sign is a useful bedside test to demonstrate hemispatial neglect. The sign is named after curious students at Eastchester High School who inquired, “What happens if you ask patients with neglect to clap their hands?” A behavioral case series meant to answer their question showed that in the acute period, patients with neglect often perform one-handed clapping motions at their midline.1 In contrast, hemiplegic patients without neglect typically bring the unaffected arm across their body to clap against the plegic hand. The presence of the Eastchester clapping sign indicates internal motor representational loss, and this simple test should be incorporated with other bimanual tasks and tests of motor and sensory neglect. While the sign provides evidence of neglect phenomena, it does not identify specific lesion localization within the distributed networks mediating spatial attention.2

STUDY FUNDING

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Correspondence to: smukerji@partners.org

Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.