Vallar Giuseppe, Calzolari Elena
Department of Psychology and NeuroMI-Milan Center for Neuroscience, University of Milano-Bicocca, and Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom.
Handb Clin Neurol. 2018;151:287-312. doi: 10.1016/B978-0-444-63622-5.00014-0.
Unilateral spatial neglect is a disabling neurologic deficit, most frequent and severe after right-hemispheric lesions. In most patients neglect involves the left side of space, contralateral to a right-hemispheric lesion. About 50% of stroke patients exhibit neglect in the acute phase. Patients fail to orient, respond to, and report sensory events occurring in the contralateral sides of space and of the body, to explore these portions of space through movements by action effectors (eye, limbs), and to move the contralateral limbs. Neglect is a multicomponent higher-level disorder of spatial awareness, cognition, and attention. Spatial neglect may occur independently of elementary sensory and motor neurologic deficits, but it can mimic and make them more severe. Diagnostic tests include: motor exploratory target cancellation; setting the midpoint of a horizontal line (bisection), that requires the estimation of lateral extent; drawing by copy and from memory; reading, assessing neglect dyslexia; and exploring the side of the body contralateral to the lesion. Activities of daily living scales are also used. Patients are typically not aware of neglect, although they may exhibit varying degrees of awareness toward different components of the deficit. The neural correlates include lesions to the inferior parietal lobule of the posterior parietal cortex, which was long considered the unique neuropathologic correlate of neglect, to the premotor and to the dorsolateral prefrontal cortices, to the posterior superior temporal gyrus, at the temporoparietal junction, to subcortical gray nuclei (thalamus, basal ganglia), and to parietofrontal white-matter fiber tracts, such as the superior longitudinal fascicle. Damage to the inferior parietal lobule of the posterior parietal cortex is specifically associated with the mainly egocentric, perceptual, and exploratory extrapersonal, and with the personal, bodily components of neglect. Productive manifestations, such as perseveration, are not a correlate of posterior parietal cortex damage.
单侧空间忽视是一种致残性神经功能缺损，在右侧半球病变后最为常见且严重。在大多数患者中，忽视涉及右侧半球病变对侧的左侧空间。约50%的中风患者在急性期会出现忽视症状。患者无法对空间和身体对侧发生的感觉事件进行定向、做出反应并报告，无法通过动作效应器（眼睛、肢体）的运动来探索这些空间部分，也无法移动对侧肢体。忽视是一种多成分的高级空间意识、认知和注意力障碍。空间忽视可能独立于基本的感觉和运动神经功能缺损而发生，但它可以模仿并使这些缺损更加严重。诊断测试包括：运动探索性目标取消；设定水平线的中点（二等分），这需要估计横向范围；临摹和凭记忆绘图；阅读，评估忽视性阅读障碍；以及探索病变对侧的身体侧面。日常生活活动量表也会被使用。患者通常没有意识到忽视的存在，尽管他们可能对缺损的不同成分表现出不同程度的意识。神经关联包括后顶叶皮质下顶叶小叶的病变，长期以来该区域被认为是忽视的唯一神经病理学关联，还有运动前区和背外侧前额叶皮质、后颞上回、颞顶交界处、皮质下灰质核（丘脑、基底神经节）以及顶额叶白质纤维束，如弓状束的病变。后顶叶皮质下顶叶小叶的损伤与主要以自我为中心的、感知性的和探索性的体外以及个人身体方面的忽视成分特别相关。诸如持续动作等表现并非后顶叶皮质损伤的关联因素。
