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Subcortical neglect: quantitation, anatomy, and recovery
Neurology
|September 1, 1987
Summary
Right hemispheric subcortical infarcts can cause hemispatial neglect and sensory extinction. While often mild, these deficits highlight the role of subcortical structures in attention and intention, with potential for cortical compensation.
Area of Science:
- Neuroscience
- Neurology
- Cognitive Psychology
Background:
- Subcortical infarcts in the right hemisphere are increasingly recognized as a cause of neurological deficits.
- Understanding the specific manifestations and underlying mechanisms of neglect following subcortical lesions is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate the frequency and severity of neglect symptoms in patients with right hemispheric subcortical infarcts.
- To explore the relationship between lesion location and specific neglect deficits.
- To elucidate the probable mechanisms underlying hemispatial neglect and sensory extinction.
Main Methods:
- Evaluation of fifteen patients with right hemispheric subcortical infarcts using CT or MRI.
- Administration of a comprehensive neglect testing battery assessing visual, tactile, and auditory modalities.
- Analysis of lesion location, particularly posterior internal capsule involvement, and its correlation with test performance.
Main Results:
- Hemispatial neglect was frequent (10/15 cases) but rarely severe (3/15 cases).
- Sensory extinction was observed across modalities: visual (3/15), tactile (3/15), and auditory (6/15).
- Large posterior internal capsule lesions correlated with greater impairment on cancellation tests.
Conclusions:
- Subcortical structures play a significant role in attentional and intentional functions, contributing to neglect syndromes.
- Striatonigral mechanisms likely explain visual and auditory extinction.
- Cortical structures may compensate for lost subcortical functions, enabling recovery in some cases.