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Spatial Neglect, Balint-Homes' and Gerstmann's Syndrome, and Other Spatial Disorders

Published online by Cambridge University Press:  07 November 2014

Abstract

Brain-damaged patients with lesion or dysfunction involving the parietal cortex may show a variety of neuropsychological impairments involving spatial cognition. The more frequent and disabling deficit is the syndrome of unilateral spatial neglect that, in a nutshell, consists in a bias of spatial representation and attention ipsilateral to of extrapersonal, personal (ie, the body) space, or both, toward the side of the hemispheric lesion. The deficit is more frequent and severe after damage to the right hemisphere, involving particularly the posterior-inferior parietal cortex at the temporo-parietal junction. Damage to these posterior parietal regions may also impair visuospatial short-term memory, which may be associated with and worsen spatial neglect. The neural network supporting spatial representation, attention and short-term memory is, however, more extensive, including the right premotor cortex. Also disorders of drawing and building objects (traditionally termed constructional apraxia) are a frequent indicator of posterior parietal damage in the left and in the right hemispheres. Other less frequent deficits, which, however, have a relevant localizing value, include optic ataxia (namely, the defective reaching of visual objects, in the absence of elementary visuo-motor impairments), which is typically brought about by damage to the superior parietal lobule. Optic ataxia, together with deficits of visual attention, of estimating distances and depth, and with apraxia of gaze, constitutes the severely disabling Balint-Holmes' syndrome, which is typically associated with bilateral posterior parietal and occipital damage. Finally, lesions of the posterior parietal lobule (angular gyrus) in the left hemisphere may bring about a tetrad of symptoms (left-right disorientation, acalculia, finger agnosia, and agraphia) termed Gerstmann's syndrome, that also exists in a developmental form.

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Review Articles
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.Critchley, M. The Parietal Lobes. New York, NY: Hafner; 1953.Google Scholar
2.Jewesbury, ECO. Parietal lobe syndromes. In: Vinken, PJ, Bruyn GW, eds. Handbook of Clinical Neurology. vol 2. Amsterdam, the Netherlands: North Holland; 1969:680699.Google Scholar
3.Vallar, G. The methodological foundations of human neuropsychology: studies in brain-damaged patients. In: Boller, F, Grafman, J, Rizzolatti, G, eds. Handbook of Neuropsychology. Vol 1. 2 ed. Amsterdam: Elsevier; 2000:305344.Google Scholar
4.Azouvi, P, Samuel, C, Louis-Dreyfus, A, et al.Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke. J Neurol Neurosurg Psychiatry. 2002;73:160166.CrossRefGoogle ScholarPubMed
5.Bowen, A, McKenna, K, Tallis, RC. Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke. Stroke. 1999;30:11961202.CrossRefGoogle ScholarPubMed
6.Buxbaum, LJ, Ferraro, MK, Veramonti, T, et al.Hemispatial neglect: subtypes, neuroanatomy, and disability. Neurology. 2004;62:749756.CrossRefGoogle ScholarPubMed
7.Bisiach, E, Vallar, G. Unilateral neglect in humans. In: Boller, F, Grafman, J, Rizzolatti, G, eds. Handbook of Neuropsychology. vol 1. 2nd ed. Amsterdam, the Netherlands: Elsevier Press; 2000:459502.Google Scholar
8.Heilman, KM, Watson, RT, Valenstein, E. Neglect and related disorders. In: Heilman, KM, Valenstein, E, eds. Clinical Neuropsychology. 4th ed. New York, NY: Oxford University Press; 2003:296346.CrossRefGoogle Scholar
9.Sterzi, R, Bottini, G, Celani, MG, et al.Hemianopia, hemianaesthesia, and hemiplegia after right and left hemisphere damage. A hemispheric difference. J Neurol Neurosurg Psychiatry. 1993;56:308310.CrossRefGoogle Scholar
10.Rizzolatti, G, Fadiga, L, Fogassi, L, Gallese, V. The space around us. Science. 1997;277:190191.CrossRefGoogle ScholarPubMed
11.Vallar, G. Extrapersonal visual unilateral spatial neglect and its neuroanatomy. Neuroimage. 2001;14(1 pt 2):S52S58.CrossRefGoogle ScholarPubMed
12.Vallar, G, Guariglia, C, Rusconi, ML. Modulation of the neglect syndrome by sensory stimulation. In: Thier, P, Karnath, H-O, eds. Parietal Lobe Contributions to Orientation in 3D Space. Heidelberg, Germany: Springer-Verlag; 1997:555578.CrossRefGoogle Scholar
13.Rossetti, Y, Rode, G. Reducing spatial neglect by visual and other sensory manipulations: non-cognitive (physiological) routes to the rehabilitation of a cognitive disorder. In: Karnath, H-O, Milner, AD, Vallar, G, eds. The Cognitive and Neural Bases of Spatial Neglect. Oxford, England: Oxford University Press; 2002:375396.Google Scholar
14.Redding, GM, Wallace, B. Prism adaptation and unilateral neglect: review and analysis. Neuropsychologia. 2006;44:120.CrossRefGoogle ScholarPubMed
15.Kerkhoff, G. Modulation and rehabilitation of spatial neglect by sensory stimulation. Prog Brain Res. 2003;142:257271.CrossRefGoogle ScholarPubMed
16.Leibovitch, FS, Black, SE, Caldwell, CB, Ebert, PL, Ehrlich, LE, Szalai, JP. Brain-behavior correlations in hemispatial neglect using CT and SPECT: the Sunnybrook Stroke Study. Neurology. 1998;50:901908.CrossRefGoogle ScholarPubMed
17.Doricchi, F, Tomaiuolo, F. The anatomy of neglect without hemianopia: a key role for parietal-frontal disconnection? Neuroreport. 2003;14:22392243.CrossRefGoogle ScholarPubMed
18.Thiebaut de Schotten, M, Urbanski, M, Duffau, H, et al.Direct evidence for a parietal-frontal pathway subserving spatial awareness in humans. Science. 2005;309:22262228.CrossRefGoogle ScholarPubMed
19.Daini, R, Angelelli, P, Antonucci, G, Cappa, SF, Vallar, G. Exploring the syndrome of spatial unilateral neglect through an illusion of length. Exp Brain Res. 2002;144:224237.CrossRefGoogle ScholarPubMed
20.Doricchi, F, Angelelli, P. Misrepresentation of horizontal space in left unilateral neglect. role of hemianopia. Neurology. 1999;52:18451852.CrossRefGoogle ScholarPubMed
21.Rorden, C, Fruhmann Berger, M, Karnath, HO. Disturbed line bisection is associated with posterior brain lesions. Brain Res. 2006;1080:1725.CrossRefGoogle ScholarPubMed
22.Na, DL, Adair, JC, Kang, Y, Chung, CS, Lee, KH, Heilman, KM. Motor perseverative behavior on a line cancellation task. Neurology. 1999;52:15691576.CrossRefGoogle ScholarPubMed
23.Nys, GM, van Zandvoort, MJ, van der Worp, HB, Kappelle, LJ, de Haan, EH. Neuropsychological and neuroanatomical correlates of perseverative responses in subacute stroke. Brain. 2006;129:21482157.CrossRefGoogle ScholarPubMed
24.Jehkonen, M, Laihosalo, M, Kettunen, JE. Impact of neglect on functional outcome after stroke: a review of methodological issues and recent research findings. Restor Neurol Neurosci. 2006;24:209215.Google ScholarPubMed
25.Pizzamiglio, L, Guariglia, C, Antonucci, G, Zoccolotti, P. Development of a rehabilitative program for unilateral neglect. Restor Neurol Neurosci. 2006;24:337345.Google ScholarPubMed
26.Rode, G, Klos, T, Courtois-Jacquiri, S, Rossetti, Y, Pisella, L. Neglect and prism adaptation: a new therapeutic tool for spatial cognition disorders. Restor Neurol Neurosci. 2006;24:347356.Google ScholarPubMed
27.Barrett, AM, Buxbaum, LJ, Coslett, HB, et al.Cognitive rehabilitation interventions for neglect and related disorders: moving from bench to bedside in stroke patients. J Cogn Neurosci. 2006;18:12231236.CrossRefGoogle ScholarPubMed
28.Bowen, A, Lincoln, NB, Dewey, M. Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database Syst Rev. 2002; Art. No. CD003586(2).Google Scholar
29.Berti, A. Unconscious processing in neglect. In: Karnath, H-O, Milner, AD, Vallar, G, eds. The Cognitive and Neural Bases of Spatial Neglect. Oxford, England: Oxford University Press; 2002:313326.Google Scholar
30.Vallar, G, Daini, R. Visual perceptual processing in unilateral spatial neglect. The case of visual illusions. In: Vecchi, T, Bottini, G, eds. Imagery And Spatial Cognition: Methods Models and Cognitive Assessment (Advances in Consciousness Research). Amsterdam, the Netherlands: John Benjamins Publishers; 2006:337362.CrossRefGoogle Scholar
31.Maravita, A. Implicit processing of somatosensory stimuli disclosed by a perceptual after-effect. Neuroreport. 1997;8:16711674.CrossRefGoogle ScholarPubMed
32.Marcel, AJ, Bisiach, E, eds. Consciousness in Contemporary Science. Oxford, England: Oxford University Press; 1988.Google Scholar
33.Vallar, G, Ronchi, R. Anosognosia for motor and sensory deficits after unilateral brain damage: a review. Restor Neurol Neurosci. 2006;24:247257.Google ScholarPubMed
34.Berti, A. Cognition in dyschiria: Edoardo Bisiach's theory of spatial disorders and consciousness. Cortex. 2004;40:275280.CrossRefGoogle ScholarPubMed
35.Kleist, K. Gehirnpathologie. Leipzig, Germany: Barth; 1934.Google Scholar
36.Rusconi, ML, Maravita, A, Bottini, G, Vallar, G. Is the intact side really intact? Perseverative responses in patients with unilateral neglect: a productive manifestation. Neuropsychologia. 2002;40:594604.CrossRefGoogle ScholarPubMed
37.Vallar, G. Spatial hemineglect in humans. Trends Cogn Sci. 1998;2:8797.CrossRefGoogle ScholarPubMed
38.Grossi, D, Trojano, L. Constructional and visuo-spatial disorders. In: Behrmann, M, ed. Handbook of Neuropsychology. vol 4. 2nd ed. Amsterdam, the Netherlands: Elsevier Press; 2001:99120.Google Scholar
39.Gainotti, G. Constructional apraxia. In: Frederiks, JAM, ed. Clinical Neuropsychology. vol 45. Amsterdam, the Netherlands: Elsevier Press; 1985:491506.Google Scholar
40.Farah, M. Disorders of visuo-spatial perception and cognition. In: Heilman, KM, Valenstein, E, eds. Clinical Neuropsychology. 4th ed. New York, NY: Oxford University Press; 2003:146160.CrossRefGoogle Scholar
41.Halligan, PW, Fink, GR, Marshall, JC, Vallar, G. Spatial cognition: evidence from visual neglect. Trends Cogn Sci. 2003;7:125133.CrossRefGoogle ScholarPubMed
42.Mesulam, M-M. Functional anatomy of attention and neglect: from neurons to networks. In: Karnath, H-O, Milner, AD, Vallar, G, eds. The Cognitive and Neural Bases of Spatial Neglect. Oxford, England: Oxford University Press; 2002:3345.Google Scholar
43.Trojano, L, Grossi, D. A critical review of mental imagery defects. Brain Cogn. 1994 24:213243.CrossRefGoogle ScholarPubMed
44.Vallar, G, Rusconi, ML, Bisiach, E. Awareness of contralesional information in unilateral neglect: effects of verbal cueing, tracing and vestibular stimulation. In: Umiltà, C, Moscovitch, M, eds. Attention and Performance XV. Conscious and Nonconscious Information Processing. Cambridge, Mass: MIT Press; 1994:377391.Google Scholar
45.McFie, J, Zangwill, OL. Visual-constructive disabilities associated with lesions of the left cerebral hemisphere. Brain. 1960;83:243259.CrossRefGoogle Scholar
46.Warrington, EK, James, M, Kinsbourne, M. Drawing disability in relation to laterality of cerebral lesion. Brain. 1966 89:5382.CrossRefGoogle ScholarPubMed
47.Gainotti, G, Tiacci, C. Patterns of drawing disability in right and left hemispheric patients. Neuropsychologia. 1970;8:379384.CrossRefGoogle ScholarPubMed
48.Rode, G, Michel, C, Rossetti, Y, Boisson, D, Vallar, G. Left size distortion (hyperschematia) after right brain damage. Neurology. 2006;67:18011808.CrossRefGoogle ScholarPubMed
49.McMonagle, P, Kertesz, A. Exploded drawing in posterior cortical atrophy. Neurology. 2006;67:1866.CrossRefGoogle ScholarPubMed
50.De Renzi, E. Disorders of Space Exploration and Cognition. Chichester, UK: John Wiley; 1982.Google Scholar
51.Solms, M, Turnbull, OH, Kaplan-Solms, K, Miller, P. Rotated drawing: the range of performance and anatomical correlates in a series of 16 patients. Brain Cogn. 1998;38:358368.CrossRefGoogle Scholar
52.Bálint, R. Seelenlähmung des ‘schauens’, optische ataxie, räumliche störung der aufmerksamkeit. Monattsschrifte für Psychiatrische Neurologie. 1909;25:5181.CrossRefGoogle Scholar
53.Rizzo, M, Vecera, SP. Psychoanatomical substrates of Bálint's syndrome. J Neurol Neurosurg Psychiatry. 2002;72:162178.CrossRefGoogle ScholarPubMed
54.Holmes, G, Horrax, G. Disturbances of spatial orientation and visual attention with loss of stereoscopic vision. Arch Neurol Psychiatr. 1919;1:385407.CrossRefGoogle Scholar
55.Rossetti, Y, Pisella, L, Vighetto, A. Optic ataxia revisited: visually guided action versus immediate visuomotor control. Exp Brain Res. 2003;153:171179.CrossRefGoogle ScholarPubMed
56.Milner, AD, Goodale, MA. The Visual Brain in Action. Oxford, England: Oxford University Press; 1995.Google Scholar
57.Gerstmann, J. Fingeragnosie: Eine umschriebene Störung der Orientierung am eigenen Körper. Wiener Klinische Wochenschrift. 1924;37:10101012.Google Scholar
58.Gerstmann, J. Zur Symptomatologie der Hirnläsionen im Ubergangsgebiet der unteren Parietal und mittleren Occipitalwindung. Nervenartz. 1930;3:691695.Google Scholar
59.Strub, RL, Geschwind, N. Localization in Gerstmann syndrome. In: Kertesz, A, ed. Localization in Neuropsychology. New York, NY: Academic Press; 1983:295321.Google Scholar
60.Roeltgen, DP, Sevush, S, Heilman, KM. Pure Gerstmann's syndrome from a focal lesion. Arch Neurol. 1983;40:4647.CrossRefGoogle ScholarPubMed
61.Morris, HH, Luders, H, Lesser, RP, Dinner, DS, Hahn, J. Transient neuropsychological abnormalities (including Gerstmann's syndrome) during cortical stimulation. Neurology. 1984;34:877883.CrossRefGoogle ScholarPubMed
62.Benton, AL. Gerstmann's syndrome. Arch Neurol. 1992;49:445447.CrossRefGoogle ScholarPubMed
63.Benton, AL. The fiction of the “Gerstmann syndrome”. J Neurol Neurosurg Psychiatry. 1961;24:176181.CrossRefGoogle ScholarPubMed
64.Critchley, M. The enigma of Gerstmann's syndrome. Brain. 1966;89:183198.CrossRefGoogle ScholarPubMed
65.Wingard, EM, Barrett, AM, Crucian, GP, Doty, L, Heilman, KM. The Gerstmann syndrome in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2002;72:403405.CrossRefGoogle ScholarPubMed
66.Mayer, E, Martory, MD, Pegna, AJ, Landis, T, Delavelle, J, Annoni, JM. A pure case of Gerstmann syndrome with a subangular lesion. Brain. 1999;122:11071120.CrossRefGoogle ScholarPubMed
67.Kinsbourne, M, Warrington, EK. The developmental Gerstmann syndrome. Arch Neurol. 1963;490501.Google Scholar
68.Benson, DF, Geschwind, N. Developmental Gerstmann syndrome. Neurology. 1970;20:293298.CrossRefGoogle ScholarPubMed
69.Suresh, PA, Sebastian, S. Developmental Gerstmann's syndrome: a distinct clinical entity of learning disabilities. Pediatr Neurol. 2000;22:267278.CrossRefGoogle ScholarPubMed
70.Noel, MP. Finger gnosia: a predictor of numerical abilities in children? Child Neuropsychol. 2005;11:413430.CrossRefGoogle ScholarPubMed
71.Fayol, M, Barrouillet, P, Marinthe, C. Predicting arithmetical achievement from neuropsychological performance: a longitudinal study. Cognition. 1998;68:6370.CrossRefGoogle ScholarPubMed
72.Andres, M, Seron, X, Olivier, E. Contribution of hand motor circuits to counting. J Cogn Neurosci. 2007;19:563576.CrossRefGoogle ScholarPubMed
73.Sato, M, Cattaneo, L, Rizzolatti, G, Gallese, V. Numbers within our hands: modulation of corticospinal excitability of hand muscles during numerical judgment. J Cogn Neurosci. 2007;19:684693.CrossRefGoogle ScholarPubMed
74.De Renzi, E, Nichelli, P. Verbal and non-verbal short-term memory impairment following hemispheric damage. Cortex. 1975;11:341354.CrossRefGoogle ScholarPubMed
75.De Renzi, E, Faglioni, P, Previdi, P. Spatial memory and hemispheric locus of lesion. Cortex. 1977;13:424433.CrossRefGoogle ScholarPubMed
76.Feigenbaum, JD, Polkey, CE, Morris, RG. Deficits in spatial working memory after unilateral temporal lobectomy in man. Neuropsychologia. 1996;34:163–17.CrossRefGoogle ScholarPubMed
77.Hanley, JR, Pearson, NA, Young, AW. Impaired memory for new visual forms. Brain. 1990;113:11311148.CrossRefGoogle ScholarPubMed
78.Hanley, JR, Young, AW, Pearson, NA. Impairment of the visuo-spatial sketch pad. Q J Exp Psychol A. 1991;43:101125.CrossRefGoogle ScholarPubMed
79.Vallar, G. Memory systems: the case of phonological short-term memory. A festschrift for cognitive neuropsychology. Cogn Neuropsychol. 2006;23:135155.CrossRefGoogle ScholarPubMed
80.Vallar, G, Papagno, C. Neuropsychological impairments of verbal short-term memory. In: Baddeley, A, Wilson, B, Kopelman, M, eds. Handbook of Memory Disorders. 2nd ed. Chichester, England: Wiley; 2002:249270.Google Scholar
81.Della Sala, S, Gray, C, Baddeley, A, Allamano, N, Wilson, L. Pattern span: a tool for unwelding visuo-spatial memory. Neuropsychologia. 1999;37:11891199.CrossRefGoogle Scholar
82.Della Sala, S, Logie, RH. Neuropsychological impairments of visual and spatial working memory. In: Baddeley, A, Wilson, B, Kopelman, M, eds. Handbook of Memory Disorders. 2nd ed. Chichester, UK: Wiley; 2002:271292.Google Scholar
83.Carlesimo, GA, Perri, R, Turriziani, P, Tomaiuolo, F, Caltagirone, C. Remembering what but not where: independence of spatial and visual working memory in the human brain. Cortex. 2001;37:457473.CrossRefGoogle Scholar
84.Smith, EE, Jonides, J. Storage and executive processes in the frontal lobes. Science. 1999;283:16571661.CrossRefGoogle ScholarPubMed
85.Malhotra, P, Jager, HR, Parton, A, et al.Spatial working memory capacity in unilateral neglect. Brain. 2005;128:424435.CrossRefGoogle ScholarPubMed
86.Malhotra, P, Mannan, S, Driver, J, Husain, M. Impaired spatial working memory: one component of the visual neglect syndrome? Cortex. 2004;40:667676.CrossRefGoogle ScholarPubMed
87.Milner, B. Interhemispheric differences in the localization of psychological processes in man. Br Med Bull. 1971;27:272277.CrossRefGoogle ScholarPubMed