Unilateral neglect syndrome clinical and topographic study of 20 subjects

Pinto Jr., Luciano Ribeiro; Saraiva, Sylvio; Sanvito, Wilson Luiz

doi:10.1590/S0004-282X1990000200008

Abstracts

Twenty patients with unilateral neglect syndrome were studied. They were 10 males and 10 females, and they ranged from 29 to 76 years of age. All were submitted to a CAT scan of the brain. Based on the findings in our sample we drew the following conclusions: the extinction phenomenon was a constant manifestation of unilateral neglect; the line crossing test proved to be most efficient for the identification of visual neglect; the right parietal lobe was the anatomical region most often involved in the unilateral neglect syndrome.

Foram estudados 20 pacientes com a síndrome da negligência unilateral (SNU), de idades variáveis entre 29 e 76 anos, sendo 10 do sexo masculino e 10 do sexo feminino, todos submetidos à tomografia axial computadorizada do crânio. Baseados nesta casuística, concluímos: o fenômeno de extinção foi manifestação constante da SNU; a prova da secção de traços foi a que se revelou mais eficaz na identificação da negligência visual; o lobo parietal direito foi a região anatômica mais freqüentemente comprometida na SNU.

Luciano Ribeiro Pinto Jr.^I; Sylvio Saraiva^II; Wilson Luiz Sanvito^III

^IProfessor Assistente - Disciplina de Neurologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

^IIProfessor Livre-Docente - Disciplina de Neurologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

^IIIProfessor Pleno. Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo - Disciplina de Neurologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

SUMMARY

Twenty patients with unilateral neglect syndrome were studied. They were 10 males and 10 females, and they ranged from 29 to 76 years of age. All were submitted to a CAT scan of the brain. Based on the findings in our sample we drew the following conclusions: the extinction phenomenon was a constant manifestation of unilateral neglect; the line crossing test proved to be most efficient for the identification of visual neglect; the right parietal lobe was the anatomical region most often involved in the unilateral neglect syndrome.

RESUMO

Foram estudados 20 pacientes com a síndrome da negligência unilateral (SNU), de idades variáveis entre 29 e 76 anos, sendo 10 do sexo masculino e 10 do sexo feminino, todos submetidos à tomografia axial computadorizada do crânio. Baseados nesta casuística, concluímos: o fenômeno de extinção foi manifestação constante da SNU; a prova da secção de traços foi a que se revelou mais eficaz na identificação da negligência visual; o lobo parietal direito foi a região anatômica mais freqüentemente comprometida na SNU.

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Dr. Luciano Ribeiro Pinto Jr. - Serviço de Neurologia, Departamento de Medicina, Santa Casa de São Paulo - Rua Cesário Mota Jr. 112 - 01221 São Paulo SP - Brasil

1. Albert ML - A simple test of visual neglect. Neurology 23:658, 1973.
2. Babinski MJ - Contribution à 1'étude des troubles mentaux dans 1'hemiplégie organique cérébrale (anosognosie). Rev Neurol 27:845, 1974.
3. Barbizet J - Le monde de 1'hémiplégique gauche: essai de théorization. In Barbizet J, Ben Hamida M, Duizabo P (eds): Le Monde de 1'Hémiplégique Gauche. Masson, Paris, 1972, pg 99.
4. Ben Hamida M - Rôle de l'hemisphère droit dans la somatoenosie: l'anosognosie, syndrome d'Anton-Babinski et troubles associes. In Ben Hamida M, Duizabo P: Le Monde de 1'Hémiplégique Gauche. Masson, Paris, 1945, pg 19.
5. Bender MB - Extinction and preciptation of cutaneous sensations. Arch Neurol Psychiat 54:1, 1945.
6. Bender MB - Perceptual interactions. In Willians D (ed): Modern Trends in Neurology. Butterworths, London, 1970, pg 1.
7. Bender MB, Feldman DS - Extinction of taste sensation: double simultaneous stimulation. Neurology 2:195, 1952.
8. Bender MB, Furlow LT - Phenomenon of visual extinction in homonymous fields and psychologic principles involved. Arch Neurol Psychiat 53:29, 1945.
9. Bender MB, Wortes SB, Cramer J - Organic mental syndrome with prenomena of extinction and allesthesia. Arch Neurol Psychiat 59:273, 1948.
10. Bisiach E, Luzzatti C - Unilateral neglect of representation space. Cortex 14:129, 1978.
11. Bisiach E. Luzzatti C, Perani D - Unilateral nesrlect representational schema and consciousness. Brain 102:609, 1979.
12. Brain WR - Visual disorientation with special reference to lesions of the cerebral hemisphere. Brain 64:244, 1914.
13. Cambier J, Elghozi D, Graveleau P, Lebetzki C - Hémiasomatognosie droite et sentiment d'amputation par lesion gauche sous-corticale: rôle de la disconnexion calleuse. Rev Neurol 140:256, 1984.
14. Caplan B - Stimulus effects in unilateral neglect. Cortex 21:69, 1985.
15. Colombo A, DeRenzi E, Faglioni P - The occurrence of visual neglect in patients with unilateral cerebral disease. Cortex 12:221, 1976.
16. Critchley M - The prenomenon of tactile inattention with special reference to parietal lesion. Brain 72:538, 1949.
17. Critchley M - The Parietal Lobes. Edward Arnold, London, 1953.
l8. Denny-Brown D, Meyer JS, Horenstein S - The significance of perceptual rivalry resulting from parietal lesion. Brain 75:433, 1952.
19. Deuel RK, Regan DJ - Parietal hemineglect and motor deficits in the monkey. Neuropsychologia 23:305, 1985.
20. Diller L, Weinberg JP - Hemi-inattention in rehabilitation: the evolution of a retional remediation program. Adv Neurol 18:63, 1977.
21. Duizabo P - Rôle de 1'hémisphère droit dans les perceptions visuelles et visuospatiales. In Barbizet J, Ben Hamida M, Duizabo P (eds): Le Monde de 1'Hémiplégique Gauche. Masson, Paris, 1972, pg 47.
22. Eidelberg E, Schwartz AS - Experimental analysis of the extinction phenomenon in monkeys. Brain 94:91, 1971.
23. Ettlinger G, Warrington E, Zangwill OL - A further study of visual-spatial agnosia. Brain 80:335, 1957.
24. Feeney DM, Wier CS - Sensory neglect after lesions of substantia nigra or lateral hypothalamus: differential severity and recovery of function. Brain Res 178:329, 1979.
25. Fredericks JAM - Disorders of the body schema. In Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Disorders of the Speech, Perception and Symbolic Behaviour. North-Holland, Amsterdam, 1969, vol 4, pg 207.
26. Gainotti G - Les manifestations de neglicence et d'inattention pour l'hemispace. Cortex 4:64, 1968.
27. Gainotti G, Messerli P. Tissoti R - Qualitative analysis of unilateral spatial neglect in relation to laterality of cerebral lesions. J Neurol Neurosurg Psychiat 35:545, 1972.
28. Gerstmann J - Problem of imperception of disease and impaired body scheme and its disorders. Arch Neurol Psychiat 48:890, 1942.
29. Goldberg ME, Robinson DL - Visual responses of neurons in monkey inferior parietal lobule: the physiologic substrate of attention and neglect. Neurology 27:350, 1977.
30. Heilman KM, Bowers D, Coslett B, Watson RT - Directional hypokinesia in neglect. Neurology 33:104, 1983.
31. Heilman KM, Valenstein E - Mechanism underlying hemispatial neglect. Ann Neurol 5:166. 1979.
32. Heilman KM, Valenstein E, Watson RT - The neglect syndrome. In Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Clinical Neuropsychology. North-Holland, Amsterdam, 1985. vol 45, pg 153.
33. Heilman KM, Van Den Abell T - Right hemisphere dominance for attention: the mechanism underlying hemispheric asymmetries of inattention (neglect). Neurology 30:327, 1980.
34. Heilman KM. Watson RT - Mechanism underlying the unilateral neglect syndrome. Adv Neurol 18:93, 1977.
35. Heilman KM, Watson RT - The neglect syndrome: a unilateral defect of the orienting response. In Harnard S (ed): Lateralization in the nervous system. Academic Press, New York, 1977, pg 285.
36. Jackson JH - Case of large cerebral tumor without optic neuritis and with left hemiplegia and imperception. In Taylor J: Selected Writings of John Hughlings Jackson. Basic, New York, 1958, pg 146.
37. Kinsbourne M - Hemi-neslect and hemisphere rivalry. Adv Neurol 18:41, 1977.
38. Lawson IR - Visual-spacial neglect in lesions of the right cerebral hemisphere. Neurolgy 12:23, 1962.
39. Lhermitte J - De l'image corporalle. Rev Neurol 74:20, 1942.
40. Ljungberg T, Ungerstedt U - Sensory inattention produced by 6-hydroxidopamine--induced degeneration of ascending dopamine neurons in the brain. Exp Neurol 53:585, 1976.
41. Marshall JF - Somatosensory inattention after dopamine depleting intracerebral 6-OHDA injections: spontaneous recovery and pharmacological control. Brain Res 177:311, 1979.
42. Marshall JF, Turner BH, Teitelbaum P - Sensory neglect produced by lateral hypothalamic damage. Science 174:523, 1978.
43. Mcfie J, Piercy MF, Zangwill OL - Visual-spacial agnosia associated with lesions of the rierht cerebral hemisphere. Brain 73:167. 1950.
44. Mazzucchi A, Pasteraro AM. Nuzzi G. Parma M - Unilateral visual agnosia. Cortex 21:309. 1975.
45. Nathan PW - On simultaneous bilateral stimulation of the body in a lesion of the parietal lobe. Brain 69:325, 1946.
46. Ogden JA - Contralesional neglect of constructed visual images in right and left brain-demaged patients. Neuropsychologia 23:273, 1985.
47. Oxbury JM, Campbell DC, Oxbury SM - Unilateral spatial neglect and impairments of spatial analysis and visual perception. Brain 97:551, 1974.
48. Reider MN - Phenomena of sensory supression. Arch Neurol Psychiat 55:583, 1946.
49. Rosenberger PB - Discriminative aspects of visual hemi-inattention. Neurology 24:17, 1974.
50. Rosenfield DB, Kinsbourne M - Neurologic aspects of behaviour. In Appel SH (ed): Current Neurology. Wiley, New York, 1981, vol 3, pg 503.
51. Roth M - Disorders of the body image caused by lesions of the right parietal lobe. Brain 72:89, 1949.
52. Sandifer PH - Anosognosia and disorders of body scheme. Brain 69:122, 1946.
53. Schwartz AS, Marchok PL, Flynn RE - A sensitive test for tactile extinction: results in patients with parietal and frontal lobe disease. J Neurol Neurosurg Psychiat 40:228, 1977.
54. Schwartz AS, Marchok PL, Kreinick CJ, Flynn RE - The asymetric lateralization of tactile extinction in patients with unilateral cerebral dysfunction. Brain 102:669, 1979.
55. Valenstein E, Heilman KM - Unilateral hypokinesia and motor extinction. Neurology 31:445, 198L
56. Valenstein E, Van Den Abell T, Tankle R, Heilman KM - Apomorphine-induced turning after recovery from neglect induced by cortical lesions. Neurology 30:358, 1980.
57. Watson RT, Heilman KM - Thalamic neglect. Neurology 29:690, 1979.
58. Watson RT, Valenstein E, Heilman KM - Thalamic neglect: possible role of the medial thalamus and nucleus reticulares in behaviour. Arch Neurol 38:501, 1981.
59. Weinstein EA, Friedland RP - Hemi-inattention and hemispheric specialization. Adv Neurol 18:1, 1977.

Unilateral neglect syndrome clinical and topographic study of 20 subjects

Síndrome da negligência unilateral: estudo clínico e topográfico de 20 casos

Publication Dates

Publication in this collection
25 May 2011
Date of issue
June 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Albert ML - A simple test of visual neglect. Neurology 23:658, 1973.

[2] 2. Babinski MJ - Contribution à 1'étude des troubles mentaux dans 1'hemiplégie organique cérébrale (anosognosie). Rev Neurol 27:845, 1974.

[3] 3. Barbizet J - Le monde de 1'hémiplégique gauche: essai de théorization. In Barbizet J, Ben Hamida M, Duizabo P (eds): Le Monde de 1'Hémiplégique Gauche. Masson, Paris, 1972, pg 99.

[4] 4. Ben Hamida M - Rôle de l'hemisphère droit dans la somatoenosie: l'anosognosie, syndrome d'Anton-Babinski et troubles associes. In Ben Hamida M, Duizabo P: Le Monde de 1'Hémiplégique Gauche. Masson, Paris, 1945, pg 19.

[5] 5. Bender MB - Extinction and preciptation of cutaneous sensations. Arch Neurol Psychiat 54:1, 1945.

[6] 6. Bender MB - Perceptual interactions. In Willians D (ed): Modern Trends in Neurology. Butterworths, London, 1970, pg 1.

[7] 7. Bender MB, Feldman DS - Extinction of taste sensation: double simultaneous stimulation. Neurology 2:195, 1952.

[8] 8. Bender MB, Furlow LT - Phenomenon of visual extinction in homonymous fields and psychologic principles involved. Arch Neurol Psychiat 53:29, 1945.

[9] 9. Bender MB, Wortes SB, Cramer J - Organic mental syndrome with prenomena of extinction and allesthesia. Arch Neurol Psychiat 59:273, 1948.

[10] 10. Bisiach E, Luzzatti C - Unilateral neglect of representation space. Cortex 14:129, 1978.

[11] 11. Bisiach E. Luzzatti C, Perani D - Unilateral nesrlect representational schema and consciousness. Brain 102:609, 1979.

[12] 12. Brain WR - Visual disorientation with special reference to lesions of the cerebral hemisphere. Brain 64:244, 1914.

[13] 13. Cambier J, Elghozi D, Graveleau P, Lebetzki C - Hémiasomatognosie droite et sentiment d'amputation par lesion gauche sous-corticale: rôle de la disconnexion calleuse. Rev Neurol 140:256, 1984.

[14] 14. Caplan B - Stimulus effects in unilateral neglect. Cortex 21:69, 1985.

[15] 15. Colombo A, DeRenzi E, Faglioni P - The occurrence of visual neglect in patients with unilateral cerebral disease. Cortex 12:221, 1976.

[16] 16. Critchley M - The prenomenon of tactile inattention with special reference to parietal lesion. Brain 72:538, 1949.

[17] 17. Critchley M - The Parietal Lobes. Edward Arnold, London, 1953.

[18] l8. Denny-Brown D, Meyer JS, Horenstein S - The significance of perceptual rivalry resulting from parietal lesion. Brain 75:433, 1952.

[19] 19. Deuel RK, Regan DJ - Parietal hemineglect and motor deficits in the monkey. Neuropsychologia 23:305, 1985.

[20] 20. Diller L, Weinberg JP - Hemi-inattention in rehabilitation: the evolution of a retional remediation program. Adv Neurol 18:63, 1977.

[21] 21. Duizabo P - Rôle de 1'hémisphère droit dans les perceptions visuelles et visuospatiales. In Barbizet J, Ben Hamida M, Duizabo P (eds): Le Monde de 1'Hémiplégique Gauche. Masson, Paris, 1972, pg 47.

[22] 22. Eidelberg E, Schwartz AS - Experimental analysis of the extinction phenomenon in monkeys. Brain 94:91, 1971.

[23] 23. Ettlinger G, Warrington E, Zangwill OL - A further study of visual-spatial agnosia. Brain 80:335, 1957.

[24] 24. Feeney DM, Wier CS - Sensory neglect after lesions of substantia nigra or lateral hypothalamus: differential severity and recovery of function. Brain Res 178:329, 1979.

[25] 25. Fredericks JAM - Disorders of the body schema. In Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Disorders of the Speech, Perception and Symbolic Behaviour. North-Holland, Amsterdam, 1969, vol 4, pg 207.

[26] 26. Gainotti G - Les manifestations de neglicence et d'inattention pour l'hemispace. Cortex 4:64, 1968.

[27] 27. Gainotti G, Messerli P. Tissoti R - Qualitative analysis of unilateral spatial neglect in relation to laterality of cerebral lesions. J Neurol Neurosurg Psychiat 35:545, 1972.

[28] 28. Gerstmann J - Problem of imperception of disease and impaired body scheme and its disorders. Arch Neurol Psychiat 48:890, 1942.

[29] 29. Goldberg ME, Robinson DL - Visual responses of neurons in monkey inferior parietal lobule: the physiologic substrate of attention and neglect. Neurology 27:350, 1977.

[30] 30. Heilman KM, Bowers D, Coslett B, Watson RT - Directional hypokinesia in neglect. Neurology 33:104, 1983.

[31] 31. Heilman KM, Valenstein E - Mechanism underlying hemispatial neglect. Ann Neurol 5:166. 1979.

[32] 32. Heilman KM, Valenstein E, Watson RT - The neglect syndrome. In Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Clinical Neuropsychology. North-Holland, Amsterdam, 1985. vol 45, pg 153.

[33] 33. Heilman KM, Van Den Abell T - Right hemisphere dominance for attention: the mechanism underlying hemispheric asymmetries of inattention (neglect). Neurology 30:327, 1980.

[34] 34. Heilman KM. Watson RT - Mechanism underlying the unilateral neglect syndrome. Adv Neurol 18:93, 1977.

[35] 35. Heilman KM, Watson RT - The neglect syndrome: a unilateral defect of the orienting response. In Harnard S (ed): Lateralization in the nervous system. Academic Press, New York, 1977, pg 285.

[36] 36. Jackson JH - Case of large cerebral tumor without optic neuritis and with left hemiplegia and imperception. In Taylor J: Selected Writings of John Hughlings Jackson. Basic, New York, 1958, pg 146.

[37] 37. Kinsbourne M - Hemi-neslect and hemisphere rivalry. Adv Neurol 18:41, 1977.

[38] 38. Lawson IR - Visual-spacial neglect in lesions of the right cerebral hemisphere. Neurolgy 12:23, 1962.

[39] 39. Lhermitte J - De l'image corporalle. Rev Neurol 74:20, 1942.

[40] 40. Ljungberg T, Ungerstedt U - Sensory inattention produced by 6-hydroxidopamine--induced degeneration of ascending dopamine neurons in the brain. Exp Neurol 53:585, 1976.

[41] 41. Marshall JF - Somatosensory inattention after dopamine depleting intracerebral 6-OHDA injections: spontaneous recovery and pharmacological control. Brain Res 177:311, 1979.

[42] 42. Marshall JF, Turner BH, Teitelbaum P - Sensory neglect produced by lateral hypothalamic damage. Science 174:523, 1978.

[43] 43. Mcfie J, Piercy MF, Zangwill OL - Visual-spacial agnosia associated with lesions of the rierht cerebral hemisphere. Brain 73:167. 1950.

[44] 44. Mazzucchi A, Pasteraro AM. Nuzzi G. Parma M - Unilateral visual agnosia. Cortex 21:309. 1975.

[45] 45. Nathan PW - On simultaneous bilateral stimulation of the body in a lesion of the parietal lobe. Brain 69:325, 1946.

[46] 46. Ogden JA - Contralesional neglect of constructed visual images in right and left brain-demaged patients. Neuropsychologia 23:273, 1985.

[47] 47. Oxbury JM, Campbell DC, Oxbury SM - Unilateral spatial neglect and impairments of spatial analysis and visual perception. Brain 97:551, 1974.

[48] 48. Reider MN - Phenomena of sensory supression. Arch Neurol Psychiat 55:583, 1946.

[49] 49. Rosenberger PB - Discriminative aspects of visual hemi-inattention. Neurology 24:17, 1974.

[50] 50. Rosenfield DB, Kinsbourne M - Neurologic aspects of behaviour. In Appel SH (ed): Current Neurology. Wiley, New York, 1981, vol 3, pg 503.

[51] 51. Roth M - Disorders of the body image caused by lesions of the right parietal lobe. Brain 72:89, 1949.

[52] 52. Sandifer PH - Anosognosia and disorders of body scheme. Brain 69:122, 1946.

[53] 53. Schwartz AS, Marchok PL, Flynn RE - A sensitive test for tactile extinction: results in patients with parietal and frontal lobe disease. J Neurol Neurosurg Psychiat 40:228, 1977.

[54] 54. Schwartz AS, Marchok PL, Kreinick CJ, Flynn RE - The asymetric lateralization of tactile extinction in patients with unilateral cerebral dysfunction. Brain 102:669, 1979.

[55] 55. Valenstein E, Heilman KM - Unilateral hypokinesia and motor extinction. Neurology 31:445, 198L

[56] 56. Valenstein E, Van Den Abell T, Tankle R, Heilman KM - Apomorphine-induced turning after recovery from neglect induced by cortical lesions. Neurology 30:358, 1980.

[57] 57. Watson RT, Heilman KM - Thalamic neglect. Neurology 29:690, 1979.

[58] 58. Watson RT, Valenstein E, Heilman KM - Thalamic neglect: possible role of the medial thalamus and nucleus reticulares in behaviour. Arch Neurol 38:501, 1981.

[59] 59. Weinstein EA, Friedland RP - Hemi-inattention and hemispheric specialization. Adv Neurol 18:1, 1977.