Published online by Cambridge University Press: 10 October 2009
Introduction
Hemispatial neglect is among the most frequent and most disabling consequences of focal brain lesions. It entails a complex constellation of neuropsychological deficits in perception and action towards the side of space opposite to a focal brain lesion, which can occur in various combinations and with various degrees of severity. These deficits may persist in the chronic stages many years beyond the acute neurological insult. Moreover, the presence of hemispatial neglect has a major impact on functional recovery and on the burden for caregivers. Although some manifestations of neglect may be very striking, especially in acute stroke patients, some deficits are frequently missed by physicians during a general neurological examination and must therefore be specifically looked for, since they can provide valuable localization signs.
Hemispatial neglect has also attracted much interest in cognitive neuroscience research because it has important implications for understanding the neurobiological substrates of important human cognitive functions, intimately connected with conscious awareness, selective attention, and the mental representation of space. Many aspects of spatial neglect are still poorly understood and debated, but recent advances in our knowledge of the neurophysiology and functional anatomy of attention have begun to shed new light on some of the possible neuropsychological underpinnings (Driver and Vuilleumier, 2001b; Corbetta and Shulman, 2002). However, this chapter will mainly concentrate on the clinical presentation and evolution of spatial neglect and related deficits, while it will only briefly describe the current hypotheses concerning the neural mechanisms of this complex disorder (for more complete reviews, see Driver et al., 2004; Kerkhoff, 2001; Halligan et al., 2003).
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