Hemispatial neglect in a patient with callosal infarction

Left hemispatial neglect, confined to right-hand and verbal responses, was exhibited by a 56-yr-old right-handed male patient with callosal lesions due to cerebral infarction. Various disconnection signs were also present. His CT and MRI scans disclosed major lesions situated in the posterior half of the genu and the whole trunk of the corpus callosum, as well as in the left medial frontal and temporo-occipital lobes. Left hemispatial neglect was invariably demonstrated in right-hand performance such as copying drawings, line bisection, matching identical figures and copying multiple digit numbers, and in verbal performance such as confrontation naming and reading aloud multiple digit numbers. In contrast, little or no right hemispatial neglect was demonstrated in tasks performed with the left hand. These findings support the hypothesis that the left hemisphere is only concerned with attending to the contralateral hemispace and that the right hemisphere is specialized for attending to both sides of space although the preponderant tendency is for attending to the contralateral hemispace. The neglect symptoms observed in our patient may be a disconnection sign which was attributable to a combination of lesions in the corpus callosum and in the left medial frontal lobe.