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Unilateral spatial neglect
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  1. Taro Shimizu1,
  2. Tomoya Abe2,
  3. Yasutoshi Akasaki2 and
  4. Hideaki Kamiishi2
  1. 1Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
  2. 2Department of Emergency Medicine, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
  1. Correspondence to Dr Taro Shimizu; shimizutaro7{at}gmail.com

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Description

A 75-year-old woman presented with acute behavioural change. She was well until 6 hours prior, when she looked bizarrely while on cooking. Her son spoke to her and noticed that she was staring at her right side. He approached her from her left side and talked to her, but she did not seem to notice him as if she was ignoring him. In addition, the son also noticed that only the left half of the leeks laid out on the cutting board remained uncut. The right half of the leeks had already been cut and cooked in a pot of miso soup. Besides, she seemed that she could not find a salt jar, which was located to her left. Despite the fact that she faced difficulty in paying attention to her left side, she did not ask her son for help as she did not seem to be troubled by her situation. He thought something wrong was happening and brought her to the hospital. She had no fever, headache or weakness. On examination, she consistently turned her head and gaze to the right. She had no contralesional weakness. When instructed to point the middle of the stethoscope tube, she grabbed the right quarter of the tube. Diffusion-weighted MRI revealed high-intensity signals in the right inferior parietal lobule (figure 1); MR angiography showed severe narrowing of the proximal right middle cerebral artery (figure 2). She was diagnosed with unilateral spatial neglect due to acute ischaemic stroke.

Figure 1

Diffusion-weighted MRI revealed high-intensity signals in the right inferior parietal lobule.

Figure 2

MR angiography showed severe narrowing of the proximal right middle cerebral artery.

Unilateral spatial neglect is characterised by symptoms of not only ignoring the contralesional side but also being ipsilesionally attracted to stimuli.1 2 In the acute phase, the patient may show an ipsilesional deviation of the head and eyes.3 The damaged lesion is typically located in the inferior parietal lobule region, as in this case. Patients who present with behavioural abnormalities are challenging to examine, but an astute observation on the deviation of the head and eyes may lead to a rapid and accurate diagnosis.

Patient’s perspective

Patient’s son: It was as if my mother could not see the left half, or rather, she was ignoring it.

Learning points

  • Patients with unilateral spatial neglect, caused by the lesion in the inferior parietal lobule, sometimes present just with behavioural abnormalities.

  • Patients with ‘behavioural abnormalities’ are challenging to examine.

  • An astute observation on the deviation of the head and eyes may lead to a rapid and accurate diagnosis.

References

Footnotes

  • Contributors TS, TA, YA and HK created the manuscript, and TS revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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