| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York |
| Transcript |
"Okay today we're going to be talking about neglect and specifically we're going to be talking about hemineglect. And for neuro-ophthalmology, that's going to be visual hemineglect, and basically that means you're neglecting half. It's not really a visual problem-it's inattention. So, the problem with the neglect people is different and they have a different set of complaints than the homonymous hemianopsia people. So it's usually a right-sided parietal lesion and it often follows a very large MCA distribution stroke, or tumor, hemorrhage something like that. And it's the right side because there's redundancy on the left side, and if you have a lesion on the right there is no redundancy. So, it can knock out the whole hemi field, and so patients who have a left homonymous hemianopsia can still move their head and see and they know that something's to the left they just can't see it. So, one of the things that we do is we have them draw a clock, and, as you know, if you're drawing a normal clock you've got a twelve, and a three, and a six, and a nine. And if you say make the time say five to two or something like that you'll get a normal clock like this. Even a homonymous hemianopsia person is going to draw a normal clock, because they know what a clock looks like. But in a patient who has neglect, they might bunch everything all up over here, and they basically won't put anything on this side. And if you ask them to make a spontaneous drawing they'll just only have half. Some of these patients have such severe neglect that they only shave one side of their face, or they only dress one side, or the glasses might be all like this because they really don't know they have another side. And the extreme of this hemineglect on the left side is a very strange complaint which is "somato-," which means bodily, "paraphrenia." So in somatoparaphrenia the patients don't even know that that's their body. So you might show the patient their hand, and if it's their left hand they'll deny it's their hand. They'll say that's your hand, or that's my sister's hand. And what's fascinating about these patients with somatoparaphrenia if you put a mirror right here, and it projects over to here, they'll say "that's my hand." Even though they just said that hand wasn't theirs. So it's the only the things on the left side. And so, for example, today we had a very fascinating patient with this who the husband said when he puts the food on the plate, like spaghetti and meatballs, she totally won't eat this side. And so then he just rotates the plate around, and she eats the other side. A person with a homonymous hemianopsia would never do that. A person with a homonymous hemianopsia learns to put the food on the right side. But also even if you were to do this they wouldn't do that half thing. So, the thing, the reason to know hemineglect is it's an inattention problem. It seems similar to a homonymous hemianopsia, but it has distinctive and characteristic differences-both in the way they copy and draw things, as well as what activities of daily living that are affected in. One of the other tests you can do is a bilateral simultaneous stimuli test and it'll extinguish on the neglect side. So, usually right parietal, usually MCA stroke, and might have the very weird complaint: somatoparaphrenia." |
