EpistemisHemispatial negligence
Specialty: Neurology.
Why it occurs
- Extensive ischemic or hemorrhagic stroke in the non-dominant parietal lobe (usually the right, with inattention of the left hemibody and space)
- Right parietal or frontoparietal brain tumor with large mass effect
- Head trauma with right parietal hematoma or hemorrhagic contusion
- Multiple sclerosis with confluent demyelinating plaques in the right hemisphere
- Chronic traumatic encephalopathy or frontotemporal lobar degeneration
Initial workup
Line bisection test, star or line cancellation test, and drawing of a clock face (where the patient concentrates all the numbers on the right side); Emergency brain MRI or head CT; CT angiography to evaluate large vessel occlusion in the right middle cerebral artery.
red flags
Hemineglect of acute onset (the patient ignores visual, tactile and even auditory stimuli coming from the left side, being able to eat only half of the plate or dress only half of his body), frequently associated with paralysis of the left hemibody (hemiparesis) and anosognosia (lack of awareness of one's own deficit), characteristic of extensive stroke of the right middle cerebral artery.
Standard management
- Reperfusion treatment (intravenous thrombolysis, mechanical thrombectomy) if it occurs in the stroke therapeutic window
- Sensory stimulation therapy of the neglected hemifield
- Neuropsychological rehabilitation with optical prism techniques and forced visual tracking.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3