Semiology of neglect: An update

Abstract

Hemispatial neglect is a common disabling condition following brain damage to the right hemisphere. Generally, it involves behavioral bias directed ipsilaterally to the damaged hemisphere and loss of spatial awareness for the contralesional side. In this syndrome, several clinical subtypes were identified. The objective of this article is to provide a nosological analysis of the recent data from the literature on the different subtypes of neglect (visual, auditory, somatosensory, motor, egocentric, allocentric and representational neglect), associated ipsilesional and contralesional productive manifestations and their anatomical lesion correlates. These different anatomical-clinical subtypes can be associated or dissociated. They reflect the heterogeneity of this unilateral neglect syndrome that cannot be approached or interpreted in a single manner. We propose that these subtypes result from different underlying deficits: exogenous attentional deficit (visual, auditory neglect); representational deficit (personal neglect, representational neglect, hyperschematia); shift of the egocentric reference frame (egocentric neglect); attentional deficit between objects and within objects (allocentric neglect), endogenous attentional deficit (representational neglect) and transsaccadic working memory or spatial remapping deficit (ipsilesional productive manifestations). Taking into account the different facets of the unilateral neglect syndrome should promote the development of more targeted cognitive rehabilitation protocols.