Left on the right or viceversa: a case of "alternating" constructional allochiria

We describe a patient with an ischemic right frontal lesion and mild left neglect who showed a systematic tendency to transpose drawings on one side of the page, which varied depending on the starting point (left or right) of his graphic productions. When not specifically cued, the patient started to draw in the ipsilesional (right) side and tended to show allochiria on the right, but occasionally, or under specific instructions, the patient started drawing from the left side and then showed a complete reversion of his spatial transpositions. To clarify the basic mechanisms underlying such a peculiar constructional phenomenon, we performed a series of experimental investigations, including extended copying tasks, a clock-marking test (to mark the position of single hours on a clock-face), and a line bisection task with progressive left-toright or right-to-left stimulus presentation. Findings suggested that "alternating" allochiria in copying and drawing from memory tasks is an epiphenomenon of a basic inability to move attention and action away from the starting point of graphic productions. The present case study, contrasted with observations on other brain-damaged patients, demonstrates that allochiria may have different neuro-cognitive bases and offers new insights for theoretical interpretations of unilateral spatial neglect.