Perceptual awareness and its loss in unilateral neglect and extinction

We review recent evidence from studies of patients with unilateral neglect and/or extinction, who suffer from a loss of awareness for stimuli towards the affected side of space. We contrast their deficit with the effects of damage to primary sensory areas, noting that such areas can remain structurally intact in neglect, with lesions typically centred on the right inferior parietal lobe. In keeping with preservation of initial sensory pathways, many recent studies have shown that considerable residual processing can still take place for neglected or extinguished stimuli, yet without reaching the patient's awareness. This ranges from preserved visual grouping processes through to activation of identity, semantics and emotional significance. Similarly to 'preattentive' processing in normals, such residual processing can modulate what will enter the patient's awareness. Recent studies have used measures such as ERPs and fMRI to determine the neural correlates of conscious versus unconscious perception in the patients, which in turn can be related to the anatomy of their lesions. We relate the patient findings to neurophysiological data from areas in the monkey parietal lobe, which indicate that these serve as cross-modal and sensorimotor interfaces highlighting currently relevant locations as targets for intentional action. We speculate on the special role such brain regions may play in perceptual awareness, seeking to explain how damage to a system which appears primarily to code space could eliminate awareness even for non-spatial stimulus properties at affected locations. This may relate to the extreme nature of 'winner-takes-all' functions within the parietal lobe, and their correspondingly strong influence on other brain areas.