Unilateral Spatial Neglect without Hemiplegia: The Output-Mode Effect Revisited.

BACKGROUND: The occurrence of unilateral spatial neglect (USN) in non-hemiplegic right-hemisphere damaged patients is rare. Earlier studies of such patients revealed a significant advantage when typical neglect tests were performed by the patient's left hand as compared to the dominant right hand. The mechanism underlying this "output-mode effect" remains elusive. METHODS: We analyzed the temporal dynamics of this effect using line-bisection task in 9 non-hemiplegic stroke patients with left-USN. RESULTS: In 4 patients tested shortly after stroke onset (≤ 6 weeks), the impact of hand laterality was variable (left-hand advantage in one patient; right-hand advantage in 2 patients; similar performance in both hands in one patient). Only later (> 6 weeks) a clear advantage of the left hand emerged in the majority of patients, similar to the earlier reports which were all based on late testing. CONCLUSIONS: We found variable dynamics in the expression of the output-mode effect in the first weeks following stroke onset, which may reflect changes of inter-hemispheric balance, related to recovery processes. We propose that therapeutic interventions aiming to manipulate the inter-hemispheric balance (e.g., by non-invasive brain stimulation) take into account the existence of such dynamics and their highly variate nature.

Spared and impaired olfactory abilities after thalamic lesions.

Olfactory information reaches olfactory cortex without a thalamic relay. This neuroanatomical substrate has combined with functional findings to suggest that, in olfaction, the typical thalamic role in sensory processing has shifted to the olfactory bulb or olfactory cortex. With this in mind, we set out to ask whether the thalamus at all plays a significant functional role in human olfaction. We tested olfactory function in 17 patients with unilateral focal thalamic lesions and in age-matched healthy controls. We found that thalamic lesions did not significantly influence olfactory detection but significantly impaired olfactory identification, and only right lesions altered olfactory hedonics by reducing the pleasantness of pleasant odors. An auditory control revealed that this shift in pleasantness was olfactory specific. These olfactory impairments were evident in explicit measures of perception, as well as in patterns of sniffing. Whereas healthy subjects modulated their sniffs in accordance with odorant content, thalamic patients did not. We conclude that, although the thalamus is not in the path of olfactory information from periphery to cortex, it nevertheless plays a significant functional role in human olfaction.

Multiperturbation analysis of distributed neural networks: the case of spatial neglect.

This study assesses the feasibility of using a multiperturbation analysis (MPA) approach for lesion-symptom mapping. We analyze the relative contribution of damage in different brain regions to the expression of spatial neglect, as revealed in line-bisection performance. The data set comprised of normalized lesion information and bisection test results from 23 first-event right-hemisphere stroke patients. Obtaining quantitative measures of task relevance for different regions of interest (ROIs), the following ROIs were found to be the most contributing: the supramarginal and angular gyri of the inferior parietal lobule, the superior parietal lobule, the anterior part of the temporo-parietal junction connecting the superior temporal and supramarginal gyri, and the thalamus. MPA is likely to play an important role in elucidating the anatomical substrate of complex functions.

Role of disengagement failure and attentional gradient in unilateral spatial neglect - a longitudinal study.

PURPOSE: To assess the importance of 'disengagement failure' and 'attentional gradient' in unilateral spatial neglect (USN) and in recovery from neglect. METHOD: Eight right-hemisphere-damaged stroke patients performed the standardized Behavioural-Inattention-Test battery for visual neglect, line-bisection tests, and two computerized reaction-time (RT) tasks: a variant of Posner's 'Spatial-Cueing' paradigm (with special emphasis on the magnitude of leftward disengagement time) and a signal-detection task (marking the spatial gradient of attention by the distribution of RTs to target stimuli in different spatial locations). The correlation between the different measures was assessed at two points in time, before and after a period of rehabilitation treatment. RESULTS: A recovery pattern could be identified in both RT paradigms. However, the correlation between standard measures of neglect and performance on both, spatial-cueing and signal-detection tasks, was weak. CONCLUSION: Neither difficulty disengaging attention from an ipsilesional stimulus nor changes in the attentional gradient can fully explain the processes underlying USN and its recovery. A large interpersonal variance exists among USN patients in the expression of disengagement and other spatial-attention deficits. Hence, individual patients should be tested by measuring different factors known to play a role in USN. This information is crucial for assigning the appropriate treatment for each patient in accord with the specific deficit revealed.