562 5Journal of Neurology, Neurosurgery, and Psychiatry 1992;55:562-565

Directional hypokinesia in spatial hemineglect: case study
G Bottini, R Sterzi, G Vallar

a

Abstract A patient with an ischaemic lesion involving the right frontal lobe and basal ganglia showed left spatial hemineglect in visuomotor exploratory tasks, requiring the use of the right unaffected hand. Her performance was, however, entirely preserved, with no evidence of neglect, when she was required to identify targets among distractors in both the left and right halves of space, and in the Wundt-Jastrow illusion test. The latter tasks do not require any arm movement in extrapersonal space. In this patient spatial hemineglect may be explained in terms of defective organisation of movements towards the left half-space (directional hypokinesia). The frontal lesion of the patient may be the neural correlate of this selective disorder. This pattern of impairment may be contrasted with the typical deficit found in patients with right brain damage with perceptual neglect. One case had a defective performance both in visuomotor and in purely perceptual tasks. Patients with spatial hemineglect typically fail to explore the half-space contralateral to the

head and eyes. Neurological examination revealed a left hypotonic hemiplegia with enhanced left tendon reflexes and a left Babinski sign, and a severe left hypoaesthesia for touch, pinprick and proprioceptive stimulations. On confrontation, the patient could accurately detect single left- and right-sided visual stimuli, but showed left extinction on bilateral simultaneous stimulation. The patient was aware of her motor deficits and did not show personal neglect for her left limbs. Blood pressure was 130/180 mm Hg, pulse 80/min, and temperature 36°C. Respiration was regular at a normal rate. Routine blood and urine examination gave normal results. ECG, chest x-ray and perfusion lung scan confirmed pulmonary embolism. A CT performed a week