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Neural basis and recovery of spatial attention deficits in spatial neglect

Nature Neurosciencevolume 8pages16031610 (2005) | Download Citation



The syndrome of spatial neglect is typically associated with focal injury to the temporoparietal or ventral frontal cortex. This syndrome shows spontaneous partial recovery, but the neural basis of both spatial neglect and its recovery is largely unknown. We show that spatial attention deficits in neglect (rightward bias and reorienting) after right frontal damage correlate with abnormal activation of structurally intact dorsal and ventral parietal regions that mediate related attentional operations in the normal brain. Furthermore, recovery of these attention deficits correlates with the restoration and rebalancing of activity within these regions. These results support a model of recovery based on the re-weighting of activity within a distributed neuronal architecture, and they show that behavioral deficits depend not only on structural changes at the locus of injury, but also on physiological changes in distant but functionally related brain areas.

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  1. 1

    Caramazza, A. Some aspects of language processing revealed through the analysis of acquired aphasia: the lexical system. Annu. Rev. Neurosci. 11, 395–421 (1988).

  2. 2

    Jackson, J.H. Evolution and dissolution of the nervous system. Br. Med. J. 1, 591, 660–703 (1884).

  3. 3

    von Monakow, C. Lokalisation der hirnfunktionen [Localization of brain functions]. J. Psychol. Neurol. 17, 185–200 (1911).

  4. 4

    Pedersen, P.M., Jorgensen, H.S., Nakayama, H., Raaschou, H.O. & Olsen, T.S. Hemineglect in acute stroke—incidence and prognostic implications. The Copenhagen stroke study. Am. J. Phys. Med. Rehabil. 76, 122–127 (1997).

  5. 5

    Appelros, P., Karlsson, G.M., Seiger, A. & Nydevik, I. Neglect and anosognosia after first-ever stroke: incidence and relationship to disability. J. Rehabil. Med. 34, 215–220 (2002).

  6. 6

    Heilman, K.M., Bowers, D., Valenstein, E. & Watson, R.T. in Neurophysiological and Neuropsychological Aspects of Spatial Neglect (ed. Jeannerod, M.) 115–150 (North-Holland, Amsterdam, The Netherlands, 1987).

  7. 7

    Halligan, P.W. & Marshall, J.C. Toward a principled explanation of unilateral neglect. Special issue: the cognitive neuropsychology of attention. Cogn. Neuropsychol. 11, 167–206 (1994).

  8. 8

    Mesulam, M.M. Spatial attention and neglect: parietal, frontal and cingulate contributions to the mental representation and attentional targeting of salient extrapersonal events. Phil. Trans. R. Soc. Lond. B 354, 1325–1346 (1999).

  9. 9

    Robertson, I.H., Mattingley, J.B., Rorden, C. & Driver, J. Phasic alerting of neglect patients overcomes their spatial deficit in visual awareness. Nature 395, 169–172 (1998).

  10. 10

    Husain, M. & Rorden, C. Non-spatially lateralized mechanisms in hemispatial neglect. Nat. Rev. Neurosci. 4, 26–36 (2003).

  11. 11

    Peers, P.V. et al. Attentional functions of parietal and frontal cortex. Cereb. Cortex (2005).

  12. 12

    Vallar, G. & Perani, D. in Neurophysiological and Neuropsychological Aspects of Spatial Neglect (ed Jeannerod, M.) 235–258 (North-Holland, Amsterdam, The Netherlands, 1987).

  13. 13

    Mort, D.J. et al. The anatomy of visual neglect. Brain 126, 1986–1997 (2003).

  14. 14

    Karnath, H.O., Ferber, S. & Himmelbach, M. Spatial awareness is a function of the temporal not the posterior parietal lobe. Nature 411, 950–953 (2001).

  15. 15

    Karnath, H.O., Fruhmann Berger, M., Kuker, W. & Rorden, C. The anatomy of spatial neglect based on voxelwise statistical analysis: a study of 140 patients. Cereb. Cortex 14, 1164–1172 (2004).

  16. 16

    Friedrich, F.J., Egly, R., Rafal, R.D. & Beck, D. Spatial attention deficits in humans: a comparison of superior parietal and temporal-parietal junction lesions. Neuropsychology 12, 193–207 (1998).

  17. 17

    Hillis, A.E. et al. Anatomy of spatial attention: insights from perfusion imaging and hemispatial neglect in acute stroke. J. Neurosci. 25, 3161–3167 (2005).

  18. 18

    Corbetta, M., Kincade, J.M., Ollinger, J.M., McAvoy, M.P. & Shulman, G.L. Voluntary orienting is dissociated from target detection in human posterior parietal cortex. Nat. Neurosci. 3, 292–297 (2000).

  19. 19

    Connolly, J.D., Goodale, M.A., Menon, R.S. & Munoz, D.P. Human fMRI evidence for the neural correlates of preparatory set. Nat. Neurosci. 5, 1345–1352 (2002).

  20. 20

    Astafiev, S.V. et al. Functional organization of human intraparietal and frontal cortex for attending, looking, and pointing. J. Neurosci. 23, 4689–4699 (2003).

  21. 21

    Kincade, J.M., Abrams, R.A., Astafiev, S.V., Shulman, G.L. & Corbetta, M. An event-related functional magnetic resonance imaging study of voluntary and stimulus-driven orienting of attention. J. Neurosci. 25, 4593–4604 (2005).

  22. 22

    Sereno, M.I., Pitzalis, S. & Martinez, A. Mapping of contralateral space in retinotopic coordinates by a parietal cortical area in humans. Science 294, 1350–1354 (2001).

  23. 23

    Silver, M.A., Ress, D. & Heeger, D.J. Topographic maps of visual spatial attention in human parietal cortex. J. Neurophysiol. 94, 1358–1371 (2005).

  24. 24

    Corbetta, M. & Shulman, G.L. Control of goal-directed and stimulus-driven attention in the brain. Nat. Rev. Neurosci. 3, 201–215 (2002).

  25. 25

    Downar, J., Crawley, A.P., Mikulis, D.J. & Davis, K.D. A multimodal cortical network for the detection of changes in the sensory environment. Nat. Neurosci. 3, 277–283 (2000).

  26. 26

    Macaluso, E., Frith, C.D. & Driver, J. Supramodal effects of covert spatial orienting triggered by visual or tactile events. J. Cogn. Neurosci. 14, 389–401 (2002).

  27. 27

    Deuel, R.K. & Collins, R.C. The functional anatomy of frontal lobe neglect in the monkey: behavioral and quantitative 2-deoxyglucose studies. Ann. Neurol. 15, 521–529 (1984).

  28. 28

    Vallar, G. et al. Recovery from aphasia and neglect after subcortical stroke: neuropsychological and cerebral perfusion study. J. Neurol. Neurosurg. Psychiatry 51, 1269–1276 (1988).

  29. 29

    Pizzamiglio, L. Recovery of neglect after right hemispheric damage: H215O positron emission tomographic activation study. Arch. Neurol. 55, 561–568 (1998).

  30. 30

    Posner, M.I., Walker, J.A., Friedrich, F.J. & Rafal, R.D. Effects of parietal injury on covert orienting of attention. J. Neurosci. 4, 1863–1874 (1984).

  31. 31

    Morrow, L.A. & Ratcliff, G. The disengagement of covert attention and the neglect syndrome. Psychobiology 16, 261–269 (1988).

  32. 32

    Kinsbourne, M. in Hemi-inattention and Hemispheric Specialization (eds. Weinstein, E. A. & Friedland, R. L.) 41–52 (Raven Press, New York, 1977).

  33. 33

    Kastner, S. & Ungerleider, L.G. Mechanisms of visual attention in the human cortex. Annu. Rev. Neurosci. 23, 315–341 (2000).

  34. 34

    Rossini, P.M. et al. Does cerebrovascular disease affect the coupling between neuronal activity and local haemodynamics? Brain 127, 99–110 (2004).

  35. 35

    Pineiro, R., Pendlebury, S., Johansen-Berg, H. & Matthews, P.M. Altered hemodynamic responses in patients after subcortical stroke measured by functional MRI. Stroke 33, 103–109 (2002).

  36. 36

    Binkofski, F. & Seitz, R.J. Modulation of the BOLD-response in early recovery from sensorimotor stroke. Neurology 63, 1223–1229 (2004).

  37. 37

    Luck, S.J., Hillyard, S.A., Mangun, G.R. & Gazzaniga, M.S. Independent hemispheric attentional systems mediate visual search in split-brain patients. Nature 342, 543–545 (1989).

  38. 38

    Hornak, J. Ocular exploration in the dark by patients with visual neglect. Neuropsychologia 30, 547–552 (1992).

  39. 39

    Lynch, J.C. & McLaren, J.W. Deficits of visual attention and saccadic eye movements after lesions of parietooccipital cortex in monkeys. J. Neurophysiol. 61, 74–90 (1989).

  40. 40

    Perenin, M.T. & Vighetto, A. Optic ataxia: a specific disruption in visuomotor mechanisms. I. Different aspects of the deficit in reaching for objects. Brain 111, 643–674 (1988).

  41. 41

    Pouget, A. & Driver, J. Relating unilateral neglect to the neural coding of space. Curr. Opin. Neurobiol. 10, 242–249 (2000).

  42. 42

    Murase, N., Duque, J., Mazzocchio, R. & Cohen, L.G. Influence of interhemispheric interactions on motor function in chronic stroke. Ann. Neurol. 55, 400–409 (2004).

  43. 43

    Heiss, W.D., Kessler, J., Thiel, A., Ghaemi, M. & Karbe, H. Differential capacity of left and right hemispheric areas for compensation of post-stroke aphasia. Ann. Neurol. 45, 430–438 (1999).

  44. 44

    Naeser, M.A. et al. Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study. Brain Lang. 93, 95–105 (2005).

  45. 45

    Brighina, F. et al. 1 Hz repetitive transcranial magnetic stimulation of the unaffected hemisphere ameliorates contralesional visuospatial neglect in humans. Neurosci. Lett. 336, 131–133 (2003).

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We thank G.L. Shulman for discussions and comments. Supported by the J. S. McDonnell Foundation, the J. S. McDonnell Center for Higher Brain Function and the National Institute of Neurological Disorders.

Author information


  1. Department of Neurology, Washington University, 660 South Euclid Avenue, St. Louis, 63110, Missouri, USA

    • Maurizio Corbetta
    • , Abraham Z Snyder
    •  & Ayelet Sapir
  2. Department of Radiology, Washington University, 660 South Euclid Avenue, St. Louis, 63110, Missouri, USA

    • Maurizio Corbetta
    •  & Chris Lewis
  3. Departments of Anatomy and Neurobiology, Washington University, 660 South Euclid Avenue, St. Louis, 63110, Missouri, USA

    • Maurizio Corbetta
    •  & Abraham Z Snyder
  4. The Rehabilitation Institute of St. Louis, 4444 Duncan Avenue, St. Louis, 63108, Missouri, USA

    • Maurizio Corbetta
  5. Department of Psychology, Washington University, 660 South Euclid Avenue, St. Louis, 63110, Missouri, USA

    • Michelle J Kincade


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Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Maurizio Corbetta.

Supplementary information

  1. Supplementary Fig. 1

    Push-pull pattern in dorsal parietal cortex, not in frontal cortex. (PDF 135 kb)

  2. Supplementary Fig. 2

    Correlation between left SPL signal magnitude and rightward bias in chronic patients (r2=0.36, P = 0.051). (PDF 44 kb)

  3. Supplementary Fig. 3

    Reactivation of TPJ as function of anatomical damage. (PDF 145 kb)

  4. Supplementary Table 1

    Demographics and neuropsychological scores neglect group. (PDF 44 kb)

  5. Supplementary Table 2

    Regions showing greater activity at acute than chronic stage. (PDF 60 kb)

  6. Supplementary Table 3

    Regions differentially responding to invalidly vs. validly cued targets at acute and chronic stage. (PDF 51 kb)

  7. Supplementary Methods (PDF 115 kb)

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