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NEUROLOGY 1987;37:1487
© 1987 American Academy of Neurology

Subcortical neglect

Quantitation, anatomy, and recovery

Jose M. Ferro, MD, Andrew Kertesz, MD, FRCP(C and Sandra E. Black, MD, FRCP(C)

Neurobehavioral Unit (Dr. Ferro), Centro de Estudos Egas Moniz, Department of Neurology, Hospital de St. Maria, Lisbon, Portugal, and the Department of Clinical Neurological Sciences (Drs. Kertesz and Black), University of Western Ontario, St. Joseph's Hospital, London, Ontario, Canada.

Fifteen patients with right hemispheric subcortical infarcts localized by CT or MRI were evaluated with a neglect testing battery. Trimodal extinction was present in one case, visual extinction in three, tactile in three, and auditory in six. Although frequent (10 cases), hemispatial neglect was rarely severe (3 cases). Three cases recovered completely. Large posterior internal capsule lesions were associated with more frequent impairment on a cancellation test. The probable mechanism of hemispatial neglect was attentional in one case and intentional in six. Visual and auditory extinction is explained by striatonigral mechanisms. Although subcortical structures participate in attentional and intentional behavior, cortical structures can substitute for their functions.

Address correspondence and reprint requests to Dr. Kertesz, Department of Clinical Neurological Sciences, St. Joseph's Hospital, London, Ontario N6A 4V2, Canada.

Supported by the Heart and Stroke Foundation of Ontario grant # AN063 to Dr. Kertesz. and a NATO grant # RG 86/0028 to Dr. Kertesz and Dr. Ferro. Dr. Black received personal support from the Heart and Stroke Foundation in 1983 and 1984.

Received May 19, 1986. Accepted for publication in final form December 30, 1986.




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