Letter to the Editor
Hemispatial neglect secondary to a traumatic brain injury
Heminegligencia espacial secundaria a traumatismo craneoencefálico
A. García-Molinaa,b,c,
, J. García-Férnandeza,b,c, C. Aparicio-Lópeza,b,c, T. Roig-Roviraa,b,c
Corresponding author
a Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
b Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
c Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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La línea divisoria que se muestra en la imagen se ha incluido específicamente para esta figura; no es visible durante la ejecución del test. b) Ejecución del paciente a los 127 días de la lesión. Se observa un marcado sesgo hacia la derecha en la colocación de los cubos. c) Ejecución del paciente transcurridos 10 días de la anterior ejecución.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. García-Molina, J. García-Férnandez, C. Aparicio-López, T. Roig-Rovira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "García-Molina" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "García-Férnandez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Aparicio-López" ] 3 => array:2 [ "nombre" => "T." 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Diagnóstico clínico vs neuroimagen" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 593 "Ancho" => 1300 "Tamanyo" => 202324 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical examination: light-near dissociation. a) Anisocoria due to mydriatic right eye. b) Intact near-response (tonic response in the RE). c) Response to instillation of 0.125% pilocarpine (RE, mydriasis caused by cholinergic denervation supersensitivity; LE, intact). d) No miosis with RE adduction (aberrant reinnervation of the OMN is ruled out).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.A. 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"apellidos" => "Roig-Rovira" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Heminegligencia espacial secundaria a traumatismo craneoencefálico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 352 "Ancho" => 1399 "Tamanyo" => 66118 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Performance on one of the tests included in the protocol for assessing visuospatial attention (Baking Tray Task).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> (a) Healthy subject: cubes are evenly distributed over the board. The dividing line shown in the picture was added intentionally to this figure; it is not visible during the test. (b) Our patient's performance 127 days after head trauma. The image shows a marked tendency to place the cubes on the right side of the board. (c) Performance 10 days after the previous testing session.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemispatial neglect is characterised by systematic omission of stimuli in the contralesional hemifield. This disorder affects such daily activities as getting dressed, eating, reading, or writing. Patients display a decreased ability to attend to, explore, and respond to novel or significant stimuli on the side opposite to the injury. This impairment cannot be attributed to presence of homonymous hemianopsia, which sometimes coexists with hemispatial neglect.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> This frequent complication of right-sided vascular lesions<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> has also been described in patients with multiple sclerosis,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> neurodegenerative diseases,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> or head trauma.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5,6</span></a> We present a case of hemispatial neglect after severe head trauma.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient is a 52-year-old right-handed man with no relevant medical history who experienced severe head trauma after falling in a suicide attempt. When the emergency medical services arrived on the scene, the patient had a Glasgow Coma Scale score of 6, a bleeding scalp wound, and numerous associated contusions. Brain CT performed when he was admitted to the emergency department displayed a comminuted fracture of the right parietal bone; the largest fragment was depressed. Subdural haematoma was identified in the right hemisphere, with a subarachnoid haemorrhage and the haemorrhagic contusion site in the parietal lobe. We found no midline shift, and the ventricular system was symmetrical and of normal size. Bone fragments were excised and the parenchyma of the right cerebral convexity was resected. A subsequent brain MRI (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) displays a right frontal parenchymal lesion; a right subdural supratentorial haematoma with a discrete mass effect on the right hemisphere and right lateral ventricle and no midline shift; multiple microbleeds in the cortical and subcortical areas of both hemispheres, and around the lateral ventricles; and signal changes in the body and splenium of the corpus callosum.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">One month after the traumatic injury, the patient was transferred to our hospital to undergo neurorehabilitation. Upon admission, he was disoriented and showed bradypsychia and psychomotor restlessness. Four months after head trauma, it was possible to conduct a formal neuropsychological examination, according to which the patient was oriented in time, space, and person and displayed preserved language skills. He showed verbal memory alterations (Rey Auditory Verbal Learning Test: short-term memory 35/75, long-term memory 2/15, and recognition 4/15) and executive dysfunction (Letter-Number Sequencing Test: 4/21; Wisconsin Card Sorting Test: number of categories 2/6, number of perseverative errors 32; Phonemic Verbal Fluency Test [3<span class="elsevierStyleHsp" style=""></span>min]: total number of words 19). During the examination, the patient was observed not paying attention to stimuli in the contralesional hemifield; homonymous hemianopsia had not been observed in the neurological examination. He was subsequently administered a specific neuropsychological testing protocol for assessing visuospatial attention (Bells Test, Ogden Figure Copying Task, Line Bisection Test, Baking Tray Task, and Reading Task); results confirmed presence of left hemispatial neglect. Ten days later, visuospatial tests were administered again; the patient showed slight improvements in task performance (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Although hemispatial neglect commonly presents in patients with lesions in the right hemisphere, recurrence after head trauma is infrequent. Left hemispatial neglect has traditionally been associated with vascular lesions in the right parietal lobe.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> At present, this condition is linked to right-hemisphere lesions, more specifically in the superior temporal gyrus, temporoparietal junction, and inferior parietal region.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> Likewise, several authors have suggested that structural changes in certain areas of the right frontal lobe may cause hemispatial neglect.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> Danckert and Ferber<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> support the idea that left hemispatial neglect is caused by extensive lesions affecting the functional system formed by those brain regions. According to these authors, a focal lesion in the inferior parietal or right superior region is not very likely to cause this condition by itself. Mesulam proposes that contralateral neglect is caused by dysfunctions in the neurocognitive network whose cortical epicentres are located in the frontal cortex (involved in the intentional component of neglect) and parietal cortex (involved in the attentional component).<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> In our patient, hemispatial neglect was probably due to presence of multiple lesions affecting function of Mesulam's proposed neurocognitive network, which plays a critical role in processing extrapersonal space. Those lesions include structural changes in the splenium of the corpus callosum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Current hypotheses postulate that hemispatial neglect may be explained by a disconnection mechanism between the 2 parietal cortices resulting from damage to the posterior corpus callosum.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">11,12</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Molina A, García-Férnandez J, Aparicio-López C, Roig-Rovira T. Heminegligencia espacial secundaria a traumatismo craneoencefálico. Neurología. 2016;31:64–66.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 488 "Ancho" => 1400 "Tamanyo" => 68048 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial T2-weighted FLAIR MRI sequences. (a) and (b) Resection of the parenchyma of the right convexity and signal changes in the splenium of the corpus callosum. (c) Hyperintensities on the right superior area of the parietal cortex may indicate presence of blood and tissue damage associated with subdural haematoma.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 352 "Ancho" => 1399 "Tamanyo" => 66118 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Performance on one of the tests included in the protocol for assessing visuospatial attention (Baking Tray Task).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> (a) Healthy subject: cubes are evenly distributed over the board. The dividing line shown in the picture was added intentionally to this figure; it is not visible during the test. (b) Our patient's performance 127 days after head trauma. The image shows a marked tendency to place the cubes on the right side of the board. (c) Performance 10 days after the previous testing session.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neglect and related disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.M. Heilman" 1 => "E. Valenstein" 2 => "R.T. 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| Year/Month | Html | Total | |
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| 2024 November | 5 | 0 | 5 |
| 2024 October | 40 | 8 | 48 |
| 2024 September | 55 | 13 | 68 |
| 2024 August | 35 | 10 | 45 |
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| 2023 November | 55 | 21 | 76 |
| 2023 October | 64 | 9 | 73 |
| 2023 September | 45 | 4 | 49 |
| 2023 August | 37 | 8 | 45 |
| 2023 July | 51 | 8 | 59 |
| 2023 June | 48 | 5 | 53 |
| 2023 May | 58 | 15 | 73 |
| 2023 April | 50 | 1 | 51 |
| 2023 March | 53 | 5 | 58 |
| 2023 February | 32 | 3 | 35 |
| 2023 January | 46 | 13 | 59 |
| 2022 December | 63 | 8 | 71 |
| 2022 November | 80 | 14 | 94 |
| 2022 October | 60 | 8 | 68 |
| 2022 September | 81 | 29 | 110 |
| 2022 August | 57 | 15 | 72 |
| 2022 July | 42 | 9 | 51 |
| 2022 June | 19 | 10 | 29 |
| 2022 May | 29 | 7 | 36 |
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| 2021 July | 32 | 9 | 41 |
| 2021 June | 33 | 7 | 40 |
| 2021 May | 55 | 10 | 65 |
| 2021 April | 138 | 16 | 154 |
| 2021 March | 70 | 8 | 78 |
| 2021 February | 50 | 12 | 62 |
| 2021 January | 58 | 10 | 68 |
| 2020 December | 56 | 16 | 72 |
| 2020 November | 58 | 8 | 66 |
| 2020 October | 38 | 13 | 51 |
| 2020 September | 32 | 11 | 43 |
| 2020 August | 47 | 17 | 64 |
| 2020 July | 29 | 10 | 39 |
| 2020 June | 28 | 9 | 37 |
| 2020 May | 42 | 20 | 62 |
| 2020 April | 21 | 12 | 33 |
| 2020 March | 51 | 10 | 61 |
| 2020 February | 27 | 11 | 38 |
| 2020 January | 38 | 8 | 46 |
| 2019 December | 33 | 11 | 44 |
| 2019 November | 26 | 7 | 33 |
| 2019 October | 35 | 7 | 42 |
| 2019 September | 44 | 9 | 53 |
| 2019 August | 25 | 0 | 25 |
| 2019 July | 37 | 21 | 58 |
| 2019 June | 80 | 25 | 105 |
| 2019 May | 184 | 15 | 199 |
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| 2019 March | 33 | 8 | 41 |
| 2019 February | 41 | 7 | 48 |
| 2019 January | 27 | 12 | 39 |
| 2018 December | 29 | 5 | 34 |
| 2018 November | 46 | 5 | 51 |
| 2018 October | 44 | 7 | 51 |
| 2018 September | 29 | 5 | 34 |
| 2018 August | 26 | 1 | 27 |
| 2018 July | 25 | 2 | 27 |
| 2018 June | 23 | 2 | 25 |
| 2018 May | 35 | 13 | 48 |
| 2018 April | 17 | 2 | 19 |
| 2018 March | 27 | 0 | 27 |
| 2018 February | 22 | 1 | 23 |
| 2018 January | 20 | 0 | 20 |
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| 2017 November | 30 | 9 | 39 |
| 2017 October | 27 | 0 | 27 |
| 2017 September | 19 | 8 | 27 |
| 2017 August | 19 | 3 | 22 |
| 2017 July | 21 | 8 | 29 |
| 2017 June | 44 | 39 | 83 |
| 2017 May | 45 | 17 | 62 |
| 2017 April | 28 | 16 | 44 |
| 2017 March | 40 | 21 | 61 |
| 2017 February | 44 | 9 | 53 |
| 2017 January | 36 | 1 | 37 |
| 2016 December | 28 | 5 | 33 |
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| 2016 October | 33 | 9 | 42 |
| 2016 September | 39 | 8 | 47 |
| 2016 August | 35 | 8 | 43 |
| 2016 July | 30 | 1 | 31 |
| 2016 June | 38 | 6 | 44 |
| 2016 May | 55 | 27 | 82 |
| 2016 April | 48 | 28 | 76 |
| 2016 March | 102 | 38 | 140 |
| 2016 February | 63 | 34 | 97 |
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