Hemispatial Neglect Syndrome with Conjugate Gaze Deviation

Clinical Characteristics

Unilateral neglect is defined as the lack of awareness of a specific body part or external environment contralateral to the site of the brain lesion, usually occurring in patients with right (nondominant) cortical strokes 1
This condition is characterized by fixed gaze deviation toward the side of the brain lesion and ignoring the contralateral side of the body and environment 1, 2
Patients with neglect do not realize they are failing to attend to one side of their world, creating significant safety concerns 1
Clinical observations may include patients donning a shirt on only one arm, shaving only half of their face, or failing to notice food on half of their lunch tray 1

The NIH Stroke Scale (NIHSS) evaluates extinction and inattention (neglect) in item 11, with scoring criteria:
- 0 = No abnormality 3
- 1 = Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one sensory modality 3
- 2 = Profound hemi-inattention or extinction to more than one modality 3
Testing and observation by a trained professional are necessary to distinguish neglect from visual field cuts, impaired attention, and planning or visuospatial abilities 1

Unilateral spatial neglect has a substantial negative impact on an individual's ability to function safely and is a significant contributor to poor prognosis after stroke 1, 2
Reading, writing, drawing, and mobility may be negatively impacted by the presence of neglect 1
Many patients with mild neglect have spontaneous improvement within weeks of onset, while those with profound neglect may improve over many months 1

Mirror therapy has shown a large positive effect on activities of daily living performance in patients with unilateral spatial neglect and is recommended as a first-line treatment 4, 5
The literature does not reveal a single intervention best suited for addressing neglect; a multifaceted approach is often helpful 1
Other potentially effective interventions include prism adaptation therapy, half-field eye patching, limb activation techniques, and non-invasive brain stimulation methods such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) 6, 5

Patient education is an important element of treatment, with the goal of teaching the patient to acknowledge the neglect 1
Safety concerns related to neglect, such as the risk of sustaining burns or injury to the affected limb, should be addressed early in the rehabilitation process 1
Combined approaches (e.g., visual scanning with limb activation) may be more effective than single interventions 5