The anatomy of spatial neglect

Spatial neglect is often perceived as a “heterogeneous collection of symptoms” with controversial anatomical correlates. However, a clear framework for core and satellite symptoms exists. Here we review the literature when viewed from the perspective of these different syndromes, and find clear pattern of anatomical injury. Specifically, the combined symptoms of biased gaze direction and search – with no awareness of these symptoms-is seen following structural damage to (particularly right hemisphere) perisylvian regions. Object centered deficits such as biased line bisection are due to more posterior (and possibly inferior) injury. Finally, extinction is associated with damage to the temporo-parietal junction. Further, we describe key choices that must be made to parse the spatial and attentional syndromes that result from right hemisphere injury, including the investigation of both acute and chronic injury as well as the use of functional and structural modalities.

► Spatial neglect is often perceived as a “heterogeneous collection of symptoms”. However, a clear framework for core and satellite symptoms exists. ► We review the literature when viewed from the perspective of these different syndromes, and find clear pattern of anatomical injury. ► The homogenous core deficit which we define as “spatial neglect” (biased gaze direction and search) is seen following damage to (particularly right) perisylvian regions. ► Object centered deficits such as biased line bisection are due to more posterior (and possibly inferior) injury. Extinction is associated with damage to the temporo-parietal junction.