Morris Michael, Mańkowska Aleksandra, Heilman Kenneth M
Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Florida College of Medicine, Gainesville, Florida.
Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida.
Cogn Behav Neurol. 2020 Mar;33(1):63-66. doi: 10.1097/WNN.0000000000000221.
Individuals with a hemispheric infarction often reveal inattention to, or neglect of, contralesional lateral space (ie, hemispatial neglect). Individuals with a bilateral ventral temporal-occipital lesion have been shown to demonstrate upper vertical neglect, and those with a bilateral parietal-occipital lesion have been shown to demonstrate lower vertical neglect. However, to our knowledge, there have been no reports of individuals with vertical neglect from a unilateral hemispheric lesion. We report on a 72-year-old, right-handed male who developed transient left hemiparesis. On examination, he had left facial weakness and he bisected horizontal lines to the left of the midline (ie, ipsilesional neglect). In addition, on a line bisection test involving nine vertical line bisections, he demonstrated downward deviation in the majority of the trials; healthy individuals deviate upward. On brain imaging, our patient revealed a cerebral infarction, primarily affecting the right temporal lobe; the temporal lobes contain the ventral attentional network that allocates attention upward. There is also some evidence that, whereas the right hemisphere mediates attention upward, the left mediates attention downward. Therefore, injury to the right temporal lobe may account for our patient's upward neglect with downward deviation. However, further studies are needed to better understand the pathophysiology of vertical neglect.
患有半球梗死的个体常常表现出对患侧对侧空间的疏忽或忽视（即偏侧空间忽视）。双侧腹侧颞枕叶病变的个体已被证明会出现上垂直忽视，而双侧顶枕叶病变的个体已被证明会出现下垂直忽视。然而，据我们所知，尚无单侧半球病变导致垂直忽视的个体报告。我们报告了一名72岁的右利手男性，他出现了短暂性左半身轻瘫。检查时，他有左侧面部无力，并且在平分水平直线时将直线中点左侧部分平分（即患侧忽视）。此外，在一项涉及九条垂直线平分的直线平分测试中，他在大多数试验中表现出向下偏移；而健康个体则向上偏移。脑部成像显示，我们的患者有脑梗死，主要影响右侧颞叶；颞叶包含向上分配注意力的腹侧注意网络。也有一些证据表明，右半球介导向上的注意力，而左半球介导向下的注意力。因此，右侧颞叶损伤可能是我们患者出现向上忽视伴向下偏移的原因。然而，需要进一步研究以更好地理解垂直忽视的病理生理学。
