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Spatial Neglect

Updated : February 22, 2024





Background

Spatial neglect syndrome, a behavioral disorder, also known as hemineglect or unilateral syndrome, is a severe condition that sometimes presents with diagnostic challenges even for professionals well-versed with this condition.  After a traumatic occurrence in the right cerebral hemisphere, typically the right posterior parietal cortex, this hemineglect syndrome typically manifests as non-dominant spatial disorientation, presenting mostly on the left side.

Spatial neglect does not always limit engagement to sensory and motor dysfunction but can also affect other components, including perceptual, representational, visuospatial, behavioral problems, etc. The most difficult component of this disease is the patient’s frequent aberrant awareness of the impairment, known as anosognosia, and the existence of emotional disturbance. Neglect is a syndrome characterized by differences in the severity and region of brain damage.

This interhemispheric imbalance leads the left hemisphere to become more active following damage to the right hemisphere, resulting in attention diversion and rightward eye movements. The existence of spatial neglect implies a dismal prognosis in the patient’s long-term ability to function independently. Clinicians can assess the degree of this unilateral neglect with the Conley Scale or the Kessler Foundation Neglect Assessment Process.

Epidemiology

In spite of the higher incidence rate of left-hemispheric strokes (54% vs. 43%), right-hemispheric strokes are associated with disproportionately more spatial neglect. Up to 82% of post-stroke patients are affected by hemineglect condition, with an average prevalence of approximately 50%.

Unlike handedness or gender, individuals with neglect after a stroke have a link with age.  According to a case study, the majority of neglected patients were older than 65 years of age. White ethnicity and a poor socioeconomic status are strongly associated with spatial neglect.

Anatomy

Pathophysiology

Spatial neglect disorder is typically caused by obstruction of cerebral blood flow, particularly the primary trunk of a right middle cerebral artery, which supplies blood to the right-sided cerebral cortex. Commonly liable regions of the right hemisphere include the right posterior parietal cortex, with involvement of the temporoparietal junction or the inferior parietal lobe.

Anosognosia and gaze disturbance typically affect the perisylvian regions of the right hemisphere, although the involvement of the temporoparietal junction and posterior inferior damage is responsible for biased line bisection and extinction.

The frontal lobe and the superior temporal cortex are less frequently affected regions of the cerebral cortex. Neglect can arise in subcortical injury through indirect impacts on cortical regions. Superior longitudinal fasciculus is the most frequently involved subcortical region in neglect disorder, although the cingulate cortex, basal ganglia and thalamus are rarely involved.

Etiology

Spatial bias is caused by a structural and functional abnormality in the brain. This cognitive impairment is primarily caused by a hemispheric stroke, specifically one affecting the non-dominant cerebral hemisphere — frequently the right cerebral hemisphere.

Neglect is mostly caused by the occlusion in the territory of the right middle cerebral artery, which causes disorientation in approximately 80% of patients in the acute stage.

Traumatic brain damage, aneurysm formation in the cerebral circulation, and neoplasia are additional prevalent reasons. Rarely, Hemineglect syndrome is caused by neurodegenerative diseases.

Genetics

Prognostic Factors

As 80% of patients with spatial neglect go undiagnosed in the beginning, it’s imperative for patients to be diagnosed early for a good prognosis. The prognosis of a patient can also be determined by performing identification tests like the cancellation test.

This test can predict the functional activity and mortality of patients 6 months post stroke. Due to reperfusion and elimination of cerebral edema, patients with neglect can frequently recover from the post-stroke acute period, resulting in increased activity in the right parietal and left prefrontal regions.

According to the NIH scale, 17% of right-brain lesioned patients and 5% of left-brain lesioned patients exhibit spatial neglect after 12 weeks. As a result of repeated falls, 23 percent of the affected patients have longer hospital stays and higher morbidity rates. The occupational functioning of people with neglect and anosognosia also declines dramatically.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK562184/

Spatial Neglect

Updated : February 22, 2024




Spatial neglect syndrome, a behavioral disorder, also known as hemineglect or unilateral syndrome, is a severe condition that sometimes presents with diagnostic challenges even for professionals well-versed with this condition.  After a traumatic occurrence in the right cerebral hemisphere, typically the right posterior parietal cortex, this hemineglect syndrome typically manifests as non-dominant spatial disorientation, presenting mostly on the left side.

Spatial neglect does not always limit engagement to sensory and motor dysfunction but can also affect other components, including perceptual, representational, visuospatial, behavioral problems, etc. The most difficult component of this disease is the patient’s frequent aberrant awareness of the impairment, known as anosognosia, and the existence of emotional disturbance. Neglect is a syndrome characterized by differences in the severity and region of brain damage.

This interhemispheric imbalance leads the left hemisphere to become more active following damage to the right hemisphere, resulting in attention diversion and rightward eye movements. The existence of spatial neglect implies a dismal prognosis in the patient’s long-term ability to function independently. Clinicians can assess the degree of this unilateral neglect with the Conley Scale or the Kessler Foundation Neglect Assessment Process.

In spite of the higher incidence rate of left-hemispheric strokes (54% vs. 43%), right-hemispheric strokes are associated with disproportionately more spatial neglect. Up to 82% of post-stroke patients are affected by hemineglect condition, with an average prevalence of approximately 50%.

Unlike handedness or gender, individuals with neglect after a stroke have a link with age.  According to a case study, the majority of neglected patients were older than 65 years of age. White ethnicity and a poor socioeconomic status are strongly associated with spatial neglect.

Spatial neglect disorder is typically caused by obstruction of cerebral blood flow, particularly the primary trunk of a right middle cerebral artery, which supplies blood to the right-sided cerebral cortex. Commonly liable regions of the right hemisphere include the right posterior parietal cortex, with involvement of the temporoparietal junction or the inferior parietal lobe.

Anosognosia and gaze disturbance typically affect the perisylvian regions of the right hemisphere, although the involvement of the temporoparietal junction and posterior inferior damage is responsible for biased line bisection and extinction.

The frontal lobe and the superior temporal cortex are less frequently affected regions of the cerebral cortex. Neglect can arise in subcortical injury through indirect impacts on cortical regions. Superior longitudinal fasciculus is the most frequently involved subcortical region in neglect disorder, although the cingulate cortex, basal ganglia and thalamus are rarely involved.

Spatial bias is caused by a structural and functional abnormality in the brain. This cognitive impairment is primarily caused by a hemispheric stroke, specifically one affecting the non-dominant cerebral hemisphere — frequently the right cerebral hemisphere.

Neglect is mostly caused by the occlusion in the territory of the right middle cerebral artery, which causes disorientation in approximately 80% of patients in the acute stage.

Traumatic brain damage, aneurysm formation in the cerebral circulation, and neoplasia are additional prevalent reasons. Rarely, Hemineglect syndrome is caused by neurodegenerative diseases.

As 80% of patients with spatial neglect go undiagnosed in the beginning, it’s imperative for patients to be diagnosed early for a good prognosis. The prognosis of a patient can also be determined by performing identification tests like the cancellation test.

This test can predict the functional activity and mortality of patients 6 months post stroke. Due to reperfusion and elimination of cerebral edema, patients with neglect can frequently recover from the post-stroke acute period, resulting in increased activity in the right parietal and left prefrontal regions.

According to the NIH scale, 17% of right-brain lesioned patients and 5% of left-brain lesioned patients exhibit spatial neglect after 12 weeks. As a result of repeated falls, 23 percent of the affected patients have longer hospital stays and higher morbidity rates. The occupational functioning of people with neglect and anosognosia also declines dramatically.

https://www.ncbi.nlm.nih.gov/books/NBK562184/