Visual Neglect - EyeWiki

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... pathophysiology, diagnosis, and management of visual neglect (visual hemi-inattention, visual hemineglect, visuospatial neglect) Createaccount Login MainPageArticlesGettingStartedHelpRecentchangesMyPortal Page Discussion Viewform Viewsource History VisualNeglect FromEyeWikiJumpto:navigation,search EnrollintheResidentsandFellowscontest EnrollintheInternationalOphthalmologistscontest ResidentsandFellowscontestrules|InternationalOphthalmologistscontestrules Originalarticlecontributedby: AumerShughoury,MD, DevinMackay,MD Allcontributors: NaghamAl-Zubidi,MD, DevinMackay,MD, SonaliSinghMD Assignededitor: SonaliSinghMD Review: AssignedstatusUptoDate  bySonaliSinghMDonJanuary11,2022. add ContributingEditors: add Contents 1DiseaseEntity 1.1Presentation 1.2Etiology 1.3Pathophysiology 2Diagnosis 2.1History&Physical 2.2Diagnostics 2.2.1PenandPaperTests 2.2.1.1CancellationTests 2.2.1.2LineBisection 2.2.1.3ObjectDrawing 2.2.2BehavioralTests 3Differentialdiagnosis 4Management 4.1AdaptiveRehabilitation 4.2SpecificInterventions 4.2.1Top-DownTechniques 4.2.2Bottom-UpTechniques 5Prognosis 6References DiseaseEntity Visualneglect(visualhemi-inattention)isaneuropsychologicaldisorderofattentioninwhichpatientsexhibitalackofresponsetostimuliinonehalfoftheirvisualfieldthatcannotbeexplainedbyprimarydamagetothevisual geniculostriate pathways.[1] Itispartofthebroader hemispatial neglectsyndromewhichfrequentlyoccursfollowingcerebralinjurytotherightparietallobe[2] andalmostalwaysaffectsthehemispacecontralateraltothecerebrallesion.[3] Itisfrequentlyseeninthecontextofcerebrovasculardisease,affectingupto5millionstrokepatientseachyear.[4] Neglectisgenerallydefinedastheinabilitytoorient,report,orrespondtosensorystimuliinaregionofspacecontralateraltoacerebrallesion.[5] Thoughthephenomenonmayoccuralongsideaprimarysensorydeficit,theunderlyingdeficitisoneofattentionratherthansensation,andthefailuretorespondtounilateralstimulimust,bydefinition,notbebetterexplainedbytheprimarysensorydeficit.[6] Neglectmaymanifestaspersonal,extra-personal,motor,orsensoryinattention.Visualneglectisthemostcommon[6] andmoststrikingmanifestationofneglect.Contralesionalvisualneglectisfrequentlyseeninthecontextofhemiplegicstroke,andrepresentsamajorsourceofmorbidity,frequentlyimpedingrehabilitationandpredictingpoorfunctionaloutcomes.[7][8][9] Patientsareoftenunawareoftheirdeficit(anosognosia),furthercomplicatingrehabilitation.[10] Thediagnosisofvisualneglectcanbedifficult,requiringcarefulclinicalevaluation.Neglectisdistinctfromotherdisordersofvisuospatialprocessingsuchasvisualextinction(pseudohemianopia)[11] orsimultanagnosia,[12] phenomenainwhichastimulusfailstobeperceivedorrecognizedonlyinthecontextofcompetingstimuli.Unlikevisualneglect,thesephenomenaonlyaffectperceptionwhencompetingstimuliarepresent;visualattentionisintactintheabsenceofcompetitivestimuli. Severevisualneglectalsorequirescarefulclinicalevaluationtodistinguishfromhomonymoushemianopia,[13][14] asbothcanpresentwithvisualfielddefectsonconfrontationandstandardvisualfieldtesting.[15] Conversely,mildvisualneglectcanpresentwithnormalvisualfieldsonconfrontation,requiringmoredetailedtestingtoidentifythedeficit.[1] Finally,visualneglectmaycoexistwithvisualextinctionandhomonymoushemianopia,complicatingthediagnosis.[2] Presentation Visualneglectprimarilypresentswithanapparentinabilitytoperceivestimuliinonehemispace,contralesionaltothecerebralinjury.Thishemispacemaybeegocentric(body-centered)orallocentric(object-centered). Patientswithdenseegocentricleftvisualneglectmayexhibitrightgazepreference,andfailtoacknowledgepersonsorobjectstotheirownleftside.[15]Thisisthemostcommonlyidentifiedformofvisualneglect.[3] Bycontrast,allocentricorobject-centeredneglectoccursrelativetothemidlineofexternalstimuli,regardlessoftheirpositioninspace.[16] Apatientexperiencingdenseallocentricvisualneglectmayonlyreadonehalfofanewspaperoreatonehalfofaplateoffood.Thistypeofneglectmayalsomanifestinobjectdrawing,placingallnumbersontheipsilesionalclockfaceduringaclock-drawingordrawingonlyonehalfofanobject.[17] Neglectcanfurthermoreinvolvepersonalstimuli(neglectofvisual stimulifromwithinthebodilyspace)orextra-personalstimuli(neglectofvisualstimulifrombeyondthebodilyspace).[18] Personalhemineglectinvolvesrecognitionofonlyonehalfofthebody,withneglectoftheotherside.Forexample,thepatientwillgroom,comb,andrespondtovisualstimuliontheipsilesionalsideofthebodyonly.[2] Hemiplegicpatientswithpersonalhemineglectmayalsoexhibitanosognosia,failuretorecognizetheirowndeficits,duetounawarenessoftheaffectedside.[3] Extra-personalneglectisoftenmoreapparentthanpersonalneglect,andcanbethemostobvioussignofvisualneglect.Thepatientwillignoreobjectsinthecontralesionalhemispace,behavingasthoughthespacedoesnotexist.Theywilloftenbumpintoobjectsandfailtorecognizefamiliarpeopleintheaffectedhemispace.[3] Itisimportanttodistinguishthepresentationofvisualhemineglectfromhomonymoushemianopia.Homonymoushemianopiatendstosharplyobeytheverticalmeridian,whereasvisualneglectrepresentsagradientofinattentionthatmaycrossoverintotheipsilateralhemispace.[17] Furthermore,patientswithhomonymoushemianopiaareusuallyawareofthevisualfielddefectandwilloftenexhibitcompensatorymechanismssuchashead-turningandeyemovementtocompensateforthevisualdefect. Bycontrast,patientswithvisualneglectareunawareoftheneglectedvisualfieldanddonotattempttocompensateforit.[19][20] However,thesedistinctionsmaybeblurredincaseswherehomonymoushemianopiaandvisualneglectarebothpresent,requiringmoredetailedtestingtoidentifythepresenceofbothsyndromes.[21] Etiology Righthemisphericlesionshaveclassicallybeenidentifiedasthemajorcauseofvisualhemi-neglect,[2] inparticularthoseaffectingthetemporo-parieto-occipitalarea.[22] Visualhemi-neglectoccurslessfrequentlyinlefthemisphericinjury,andthepresentationtendstobelesssevere.[2]  Visualneglectarisesmostfrequentlyduetomiddlecerebralarterystroke[22]affectingtherightinferiorparietallobe[23] andparieto-occipitaljunction.[5] Upto80%ofstrokepatientswithparietallobeinvolvementexhibitsomelevelofvisualneglect.[24]Visualneglecthasalsobeendescribedinthecontextofposteriorcerebralarterystroke[25][26] andfrontallobeinfarction.[27] Lesscommonly,strokeinvolvingsub-corticalstructuressuchasthethalamus[28] andbasalganglia[29][30] mayalsocausevisualneglect. Visualneglecthasalsobeenreportedasasequelaoftraumaticbraininjury,[31][32]posteriorcorticalatrophy,[33][34] andintracranialmalignancy.[35] Finally,visualneglecthasbeenreportedasamanifestationofconversiondisorder.[36] Pathophysiology Severaltheorieshavebeenproposedregardingtheneurologicbasisofvisualneglect.[17] Themostprominentviewisthatvisualneglectisaproblemofdirectedattention.Consciousvisualperceptionrequirestwomajorcomponents:intactafferentvisualpathways(theeyes,opticnerves,chiasm,optictracts, geniculostriate pathway,andvisualcortex)andintactvisualawareness.Itisthoughtthatvisualneglectisadeficitofvisualawareness,representingimpaireddirectedattentiontowardsvisualstimulidespiteintactafferentvisualpathways.[1] Spatialprocessingandattentionisprimarilymediatedbytherightfrontalandparietallobes.[2] Lesionsaffectingthesestructurescausecontralesionaldeficitsindirectedattentionandspatialprocessingandgiverisetovisualneglect. Thepreciseneuroanatomyofvisualneglectiscomplexandremainsamatterofconsiderablecontroversy.Ithasbeenhypothesizedthatattentionisspecificallymediatedbyanintricateneuralnetworkinvolvingtherightparietallobe,frontallobe,andcingulategyrus.[37][38] Disruptionofthisnetworkmaythereforecausecontralesionaldeficitsinattentiondirectedtowardsthelefthemispace.Therehasalsobeenevidencetosuggestthatpersonaland extrapersonal attentionaremediatedbytwodistinctnetworks,oneintherightparietallobemediatingpersonalattentionandanotherinvolvingtherightfrontallobeandsuperiortemporalgyrusmediating extrapersonal attention,accountingforvariationsinthepresentationofneglect.[18] RecentfMRIstudieshavefoundthattheleftcerebralhemisphereinpatientswith hemispatial neglectmaybeoverlyactivecomparedtotheright,[39]suggestingafunctionalimbalancethatbiasesattentiontowardstherighthemispace.[4] Thisisfurthersuggestedbystudiesdemonstratingthattemporarydisruptionofcontralesionalcorticalnetworksusingtranscranialmagneticstimulation(TMS)decreasesseverityofneglect.[40]TMSdisruptionofneuralnetworksintherightposteriorparietalcortexandsuperiortemporalgyrushasalsobeenshowntotemporarilyinducesymptomsoflefthemineglectinhealthypatients.[41] Diagnosis History&Physical Thediagnosisofvisualneglectisestablishedbasedonbothclinicalpresentationanddiagnostictesting.Historyisoftensignificantforrighthemisphericstrokeorothercorticalinjury.Physicalexammaydemonstrateanipsilesional(usuallyrightward)deviationoftheeyesandheadatrest.[42] Behavioralfeaturesincludelackofobservationorexplorationofasinglehemispace,usuallycontralateraltothecorticallesion.[2] Diagnostics Alone,nosingletestforvisualneglectissufficientlysensitivefordiagnosis.Testresultsmustbecombinedwithsupportivefindingsfrompatienthistoryandclinicalobservation.Combinationsoftestsmaybeperformedtoincreasesensitivity,[43] andseveraltestbatterieshavebeenproposed.[15]Themostcommonlyemployedclinicaldiagnosticsmaygenerallybedividedintotwotypes:penandpapertestsandbehavioraltests. PenandPaperTests Testingforvisualneglectintheclinicalsettingisusuallyperformedwithbedsidepenandpapertestsduetotheirfacilityandrelativesensitivity.Threemajortypesofbedsidepenandpapertestsaretypicallyusedinthediagnosisofvisualneglect:cancellationtests,theline-bisectiontest,objectdrawing,andreading.[2] CancellationTests Cancellationtestsarethemostsensitiveindicatorsofvisualneglect.[44] Additionally,cancellationtestingcanbeusedtoquantifytheseverityofvisualneglectandtrackitsclinicalprogression.[45] Thesetestsgenerallyinvolveaskingthepatienttoidentifyandcrossoutcertaintargetitemsdistributedacrossasheetofpaper. Thepatientisscoredonhowmanytargetsareidentifiedandmarked.Patientswithhemineglectwillpreferentiallycrossoutobjectsontheipsilesionalsideofthepageandignoreobjectsonthecontralesionalsideofthepage. Severaltypesofcancellationtesthavebeendescribed.Themostcommonare: Line-CrossingTest:[46] Fortyshortlinesaredistributedindifferentorientationsseeminglyatrandomacrossthepage,withanevennumberoflinesineachhalfofthepage.Thepatientisaskedtocrossoutallofthelinesandperformanceisscoredbasedonhowmanyoftheperipherallinesarecrossedout. LetterCancellationTest:[47] Alargearrayoflettersisdistributedacrossthepageatrandom,witheachhalfofthepagecontaininganequalnumberofaspecifictargetletter.Thepatientisaskedtocrossoutallinstancesofthetargetletterandscoredonhowmanylettersarecrossedout. StarCancellationTest:[48] Alargearrayofletters,shortwords,andstarsarespreadoutatrandomacrossthepage,withanequalnumberofstarsoneachhalfofthepage.Thepatientisaskedtocrossoutallofthestarsandscoredonthenumberofstarscrossedout. BellsTest:[49] Sevenverticalcolumns,eachcontainingfivebellsandfortydistractors,aredistributedevenlyacrossthepage,withthreecolumnsineachhalfofthepageandonecolumndownthecenter.Thepatientisaskedtocrossoutallofthebellsandscoredonthenumberofbellscrossedoutinthenon-centralcolumns. Amongthecancellationtests,theLetterCancellationandBellstestshavebeenshowntohavethehighestsensitivityforvisualneglect.[43] TheStarCancellationtesthasalsobeenshowntobeahighlysensitivemeasureofneglect.[48] LineBisection Thelinebisectiontest[50] isoneoftheoldestandmosteasilyemployedtestsforvisualneglect.Severallong(15-20cm),parallelhorizontallinesaredrawndownthepageshiftedhorizontallyrelativetooneanothersuchthatanequalnumberoftheircenterslieeithertotheleft,right,oralongthecenterofthepage.Thepatientisaskedtobisecteachlineatitsmidpointwithasinglemarkwithoutmovingthepage.Apatientwithvisualneglectwillbisectthelinesunequally,withthemidpointsshiftedawayfromthecenterandtowardstheipsilesionalside.Totalneglectoftwoormorelineshasalsobeenshowntoreliablydetectvisualneglect.[50] Thetestmayalsobeperformedwithasingleline.Performancemaybescoredbymeasuringdeviationasapercentageofthehalf-lengthoftheline.[44] Thistoolisparticularlyvaluablefordistinguishingvisualneglectfromhomonymoushemianopia.[21] Unlikepatientswithvisualneglect,patientswithhomonymoushemianopiawilltendtodeviatetowardsthe contralesionalsideonlinebisection.[51][52] Thatis,apatientwithlefthomonymoushemianopiawillplacethemidpointsleftofcenter,whereasapatientwithleftvisualneglectwillplacethemidpointsrightofcenter.Inpatientswithbothhomonymoushemianopiaandvisualneglect,largeipsilesionaldeviationsareobserved,morethanwouldbeexpectedinpurevisualneglect.[53] Importantly,healthyindividualsmayalsoexhibiterroronthelinebisectiontest,mostfrequentlyerringinthedirectionofthehandusedtoperformthetest.Thisphenomenonof“pseduoneglect”[54] mustbeclinicallydistinguishedfrompathologicerrorwhentestingforvisualneglect. ObjectDrawing Despitetheirfrequentclinicalutilization,objectdrawingtestsaretheleastsensitiveandspecifictestsforvisualneglect.[43][55] Patientswithvisualneglectwhoareaskedtodrawanobjectwilloftenomitdetailsfromthecontralesionalhalfoftheimage. Thisismostcommonlyseeninaclock-drawing,wherethepatientwithvisualneglectplacesallofthenumbersononesideoftheclockface. BehavioralTests Behavioraltestinginvolvesscoringthepatient'sperformanceofspecific,real-lifetaskssuchaspicturescanning,telephonedialing,textreading,timetelling,navigation,sorting,andtextcopying.[56]Behavioraltestinggenerallyhasmuchhighersensitivityforvisualneglectthanpenandpapertests.[43] Readingtestsinparticulararesimpletoemployintheclinicandhavehighsensitivityforvisualneglect.[43] Patientsareaskedtoreadseveralhorizontallinesoftextdownthepageandscoredbasedonthenumberofwordsomittedanddifferencesbetweenrightandleftomissions. Combinedbatteriesofpenandpaperandbehavioraltestshavealsobeendevelopedtoincreasediagnosticaccuracy, includingtheBehavioralInattentionTest(BIT)andtheCatherine Bergego Scale(CBS).[3][15] Thesetestsarehighlysensitiveandspecificforvisualneglect[43] andarepredictiveofdailyfunctionalperformance.[57] However,thetime-intensivenatureofthesetestslimitstheiruseinroutineclinicalevaluation. Differentialdiagnosis Homonymoushemianopia Visualextinction(simultanagnosia) BalintSyndrome Representationalneglect Management Noconsensushasbeenestablishedregardingthebestrehabilitationstrategies,[58] andtherehasbeenlimitedevidencetosupportthelong-termefficacyofanyparticulartherapy.[58] AdaptiveRehabilitation Conventionalstrategiesforrehabilitationofvisualneglecthavelargelyfocusedonadaptivetechniquestohelpthepatientlearntofunctionusingasinglehemispace.[1] Forexample,importantobjectsarealwayspresentedtothenon-neglectedside,andcontactsaretaughttoapproachandaddressthepatientfromthisside. SpecificInterventions Top-DownTechniques “Top-down”techniquesinvolvetheuseofbehavioraltrainingtoinducecognitivechangesthatcounteractneglect.Mostcommonly,theyinvolvetrainingthepatienttoscantowardstheneglectedside(“visualscanning”or“visualexploration”).[59] Thesetherapieshavetraditionallyformedthemainstayoftreatmentforvisualneglect[58]andtherehasbeensomehigh-qualityevidencetosupporttheirefficacy.[60] However,thesetechniquesrequireconsiderabletrainingtimetoyieldlastingresults,andoftenimprovementislimitedinscope.[58] Moreover,becausetheyrelyonvoluntaryeffort,thesestrategiesfallshortincaseswherethepatientdoesnotrecognizetheirdeficit(anosognosia).[61] Bottom-UpTechniques Becausevisualneglectisoftencomplicatedbyanosognosia,rehabilitationstrategiesthatdonotrelyonvoluntaryreorientationofattentionarefrequentlyrequired.Therecoveryofspatialattentiondeficitsinvisualneglecthasbeenshowntocorrelatewiththere-activationofdefectiveneuralpathwaysandthere-orientationofnormalactivitywithinthecerebralhemispheres.[4] Thuscertaininterventionshavebeenproposedtore-balancecognitivespatialrepresentation.These“bottom-up”therapiesattempttoinduceacontralesionalorientationbiastocounteractthepathologicipsilesionalorientationbiasofvisualneglectwithoutrelyingonpatientvolition.[58][59] Themostcommonlystudiedbottom-uptechniquesincludeprismadaptation,optokineticstimulation,vestibularstimulation,andneck-musclevibration.However,evidencetosupportthelong-termefficacyofalloftheseinterventionsremainslimited.[59] PrismAdaptation: Prismadaptationhasreceivedagreatdealofattentionandisoneofthemostwell-supportedandmostwidely-employedbottom-uptherapiesforvisualneglect.[62] Rehabilitationbyprismadaptationinvolvestheuseofwedge-prismstocauseanipsilesionalshiftinvisualfields,producingarelativedisconnectbetweenvisualandmotorfunction.Patientsaskedtopointtowardsavisualizedtargetwillthereforeinitiallyerrinthedirectionoftheprismaticvisualshift(ipsilesional).Asthepatientlearnstocorrectforthevisualdeviation,itisthoughtthatacontralesionalorientationbiasisentrained.[63] Oncetheprismsareremoved,thiscontralesionalbiasideallyremains,offsettingtheipsilesionalorientationbiasofthevisualneglect.Thereisevidencetosuggestthatrepetitiveiterationsofthisprismadaptationprocessmayproducesignificantandlastingeffectsontheseverityofvisualneglect.[64][65] However,othersnotelimitedimprovementwithshort-termprismtherapyinclinicalpractice,[1] andthelong-termefficacyofthistechniquehasbeenquestioned.[59][62]Prismtherapymaybeofferedbylow-visionspecialistsintherehabilitationofvisualneglect. OptokineticStimulation(OKS): OptokineticStimulation(OKS)isaninvestigationaltherapythatinvolvesexposingthepatienttoseveralvisualstimulicontinuouslymovingtowardstheaffectedneglectedhemispace(usuallyleft).Patientsareaskedtofollowthestimuliusingsmoothpursuitmovementsandrepeatedlyreturntheireyestotheipsilesionalsidewithoutmovingtheirhead. Thiseffectivelyproducesanystagmuswiththefastphasetowardsthesideofthelesion.[66]Whenthescreenencompassesthepatient’speripheralvision,theexperienceproducesthesubjectiveimpressionofheadmovementtowardstheipsilesionalside.[58]Itisthoughtthatdoingsoinducesare-orientingcontralesionalspatialbias.[67] SeveralstudieshavedemonstratedthatOKStherapyleadstosignificantandlastingimprovementinneglectbehaviorandperformanceoncancellationandline-bisectiontesting.[58][68] VestibularStimulation: Vestibularstimulationisaninvestigationaltherapythatinvolvesusingthe vestibulo-ocularreflextoelicitvestibularnystagmusinwhichthefastphasebeatstowardsthesideofthelesion.AsinOKS,thiscausestheillusionofipsilesionalheadmotionwhichisthoughttoinduceare-orientingcontralesionalspatialbias.The vestibulo-ocularreflexcanbeelicitedusingcaloricstimulation(warmwaterintheipsilesionalearorcoldwaterinthecontralesionalear)orgalvanicstimulation(electricalstimulationofthevestibularnervebyelectrodesappliedtothemastoids).Bothmethodshavebeendemonstratedtoameliorateneglectsymptomsinseveralstudies.[58]However,littleworkhasbeendonetoevaluatethelastingeffectsofsuchtherapy,anditslong-termutilityhasnotyetbeendefinitivelyestablished. Neck-MuscleVibration(NMV): Neck-musclevibration(NMV)isaninvestigationaltherapythatreliesonproprioceptivesignalstoinducere-orientingcontralesionalspatialbias. Asymmetricalvibrationofthecontralesionalneckmusclesisinterpretedbythebrainasalengtheningofthecontralesionalneckmuscles,creatingtheillusionofheadturningtowardstheipsilesionalside.[58] NMVtherapyhasbeenshowntoinducelastingimprovementinneglectbehaviorandperformanceoncancellationtesting.[69]However,itsuseremainsinvestigational.    Prognosis Theprognosisofuntreatedvisualneglectisgenerallygood.[70] Ithasbeensuggestedthataround25%ofpatientsattaincompleterecoveryfromvisualneglectwithinthreemonthsofcerebralinjury.[71] However,theseverityofvisualneglecthasbeenshowntobeareliablepredictoroffunctionaloutcomesafterstroke,[8][9][10] andpersistentneglectrepresentsamajorsourceofstroke-relatedmorbidity.[72] References ↑1.01.11.21.31.4Pelak VS.VisualNeglect(Hemi-inattention).In:LiuGT,VolpeNJ, Galetta SL,eds. Liu, Volpe,and Galetta’s Neuro-Ophthalmology.3rded.ElsevierInc.; 2019:350-352. ↑2.02.12.22.32.42.52.62.7LiK,MalhotraPA.Spatialneglect. Pract Neurol.2015;15(5):333-339.  ↑3.03.13.23.33.4TingDSJ,PollockA,DuttonGN,etal.VisualNeglectFollowingStroke:CurrentConceptsandFutureFocus. Surv Ophthalmol.2011;56(2):114-134. ↑4.04.14.2Corbetta M, Kincade MJ,LewisC,SnyderAZ,SapirA.Neuralbasisandrecoveryofspatialattentiondeficitsinspatialneglect. Nat Neurosci.2005;8(11):1603-1610.  ↑5.05.1HeilmanKM,WatsonR, Valenstein E.Neglectandrelateddisorders.In:HeilmanKM, Valenstein E,eds. ClinicalNeuropsychology.3rded.Oxford:OxfordUniversityPress;1993:279-336. ↑6.06.1HeilmanKM, Valenstein E,WatsonRT.Neglectandrelateddisorders. Seminarsin Neurology.1984;4(2):209-219. ↑DenesG, Semenza C, Stoppa E,LisA.UnilateralSpatialNeglectandRecovery From Hemiplegia. Brain.1982;105(3):543-552. ↑8.08.1Jehkonen M, Ahonen JP, Dastidar P,etal.Visualneglectasapredictoroffunctionaloutcomeoneyearafterstroke. ActaNeurologicaScandinavica.2000;101(3):195-201. ↑9.09.1DiMonacoM,SchintuS,DottaM,BarbaS,TapperoR,GindriP.Severityofunilateralspatialneglectisanindependentpredictoroffunctionaloutcomeafteracuteinpatientrehabilitationinindividualswithrighthemisphericstroke. ArchivesofPhysicalMedicineandRehabilitation.2011;92(8):1250-1256. ↑10.010.1GialanellaB,MattioliF.AnosognosiaandExtrapersonalNeglectasPredictorsofFunctionalRecoveryfollowingRightHemisphereStroke.NeuropsychologicalRehabilitation.1992;2(3):169-178. ↑RiddochMJ,RappaportSJ,HumphreysGW.Extinction:awindowintoattentionalcompetition. ProgressinBrainResearch.2009;176:149-159. ↑MazzaV.Simultanagnosiaandobjectindividuation. CognitiveNeuropsychology.2017;34(7-8):430-439. ↑WalkerR,FindlayJM,YoungAW,WelchJ.Disentanglingneglectandhemianopia. Neuropsychologia.1991;29(10):1019-1027. ↑KooistraC,HeilmanK.Hemispatialvisualinattentionmasqueradingashemianopia. Neurology.1989;39:1125-1127. ↑15.015.115.215.3PartonA,MalhotraP,HusainM.Hemi-spatialneglect. JournalofNeurology,Neurosurgery&Psychiatry.2004;75:13-21. ↑HillisAE,RappB,BenzingL,CaramazzaA.Dissociablecoordinateframesofunilateralspatialneglect:“Viewer-centered”neglect. BrainandCognition.1998;37(3):491-526. ↑17.017.117.2KerkhoffG.Spatialhemineglectinhumans. Progressinneurobiology.2001;63:1-27.  ↑18.018.1CommitteriG,PitzalisS,GalatiG,etal.Neuralbasesofpersonalandextrapersonalneglectinhumans. Brain.2007;130(2):431-441. ↑MeienbergO,ZangemeisterWH,RosenbergM,HoytWF,StarkL.Saccadiceyemovementstrategiesinpatientswithhomonymoushemianopia. AnnalsofNeurology.1981;9(6):537-544. ↑IshiaiS,FurukawaT,TsukagoshiH.Eye-fixationpatternsinhomonymoushemianopiaandunilateralspatialneglect. Neuropsychologia.1987;25(4):675-679. ↑21.021.1BartolomeoP.VisualNeglect.CurrentOpinioninNeurology.2007;20:381-386. ↑22.022.1VallarG.Spatialhemineglectinhumans. TrendsinCognitiveSciences.1998;2(3):87-97. ↑DriverJ,MattingleyJB.Parietalneglectandvisualawareness. NatureNeuroscience.1998;1(1):17-22. ↑StoneSP,HalliganPW,GreenwoodRJ.TheIncidenceofNeglectPhenomenaandRelatedDisordersinPatientswithanAcuteRightorLeftHemisphereStroke. AgeandAgeing.1993;22:46-52. ↑ParkKC,LeeBH,KimEJ,etal.Deafferentation-Disconnectionneglectinducedbyposteriorcerebralarteryinfarction. Neurology.2006;66(1):56-61. ↑BirdCM,MalhotraP,PartonA,CoulthardE,RushworthMFS,HusainM.Visualneglectafterrightposteriorcerebralarteryinfarction. JournalofNeurology,NeurosurgeryandPsychiatry.2006;77(9):1008-1012. ↑HusainM,KennardC.Visualneglectassociatedwithfrontallobeinfarction. JournalofNeurology.1996;243(9):652-657. ↑WatsonRT,ValensteinE,HeilmanKM.ThalamicNeglect:PossibleRoleoftheMedialThalamusandNucleusReticularisinBehavior. ArchivesofNeurology.1981;38(8):501-506. ↑HealtonEB,NavarroC,BressmanS,BrustJC.Subcorticalneglect. Neurology.1982;32(7):776-778. ↑VallarG,PeraniD.TheAnatomyofUnilateralNeglectAfterRight-HemisphereStrokeLesions. Neuropsychologica.1986;24(5):609-622. ↑ButterCM,EvansJ,KirschN,KewmanD.AltitudinalNeglectFollowingTraumaticBrainInjury:ACaseReport. Cortex.1989;25(1):135-146. ↑GoodrichGL,KirbyJ,CockerhamG,IngallaSP,LewHL.Visualfunctioninpatientsofapolytraumarehabilitationcenter:Adescriptivestudy. JournalofRehabilitationResearchandDevelopment.2007;44(7):929-936. ↑SilveriMC,CiccarelliN,CappaA.UnilateralSpatialNeglectinDegenerativeBrainPathology. Neuropsychology.2011;25(5):554-566. ↑AndradeK,SamriD,SarazinM,etal.Visualneglectinposteriorcorticalatrophy. BMCNeurology.2010;10(1):68-74. ↑WillangerR,DanielsenUT,AnkerhusJ.Visualneglectinright‐sidedapoplecticlesions. ActaNeurologicaScandinavica.1981;64(5):327-336. ↑SajA,ArzyS,VuilleumierP.FunctionalBrainImaginginaWomanWithSpatialNeglectDuetoConversionDisorderTo. JAMA.2009;302(23):2552-2554. ↑MesulamM.ACorticalNetworkforDirectedAttentionandUtlllateralNeglect. AnnalsofNeurology.1981;10:309-325. ↑MesulamMM.Spatialattentionandneglect:parietal,frontalandcingulatecontributionstothementalrepresentationandattentionaltargetingofsalientextrapersonalevents.PhilosophicalTransactionsoftheRoyalSocietyofLondon.SeriesB:BiologicalSciences.1999;354(1387):1325-1346. ↑SuchanJ,RordenC,KarnathHO.Neglectseverityafterleftandrightbraindamage. Neuropsychologia.2012;50(6):1136-1141.doi:10.1016/j.neuropsychologia.2011.12.018 ↑ShindoK,SugiyamaK,HuabaoL,NishijimaK,KondoT,IzumiSI.Long-termeffectoflow-frequencyrepetitivetranscranialmagneticstimulationovertheunaffectedposteriorparietalcortexinpatientswithunilateralspatialneglect. JournalofRehabilitationMedicine.2006;38(1):65-67. 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