Visual and tactile size distortion in a patient with right neglect.

One typical feature of the neglect syndrome in patients with right hemisphere damage is that they bisect horizontal lines to the right of centre. It has been argued that to a large extent these bisection errors can be attributed to a perceptual change whereby the patient experiences the left half of a line as shorter than the right half, causing them to set the midpoint of the line towards the right. We describe here a patient with a left hemisphere lesion and rightward neglect, who consequently makes bisection errors in a leftward direction. We carried out a series of tests which confirmed that he shows a subjective visual distortion in the converse direction, i.e. a perception of horizontal extents on the right as shorter than extents on the left. We also found that he shows a similar distortion in his tactile perception. The association of visual and tactile distortions in this patient is compatible with the view that the distortion effects have a rather high-level origin. Multiple single-case studies will, however, be required to establish whether this association of deficits is typical, or whether visual and tactile size distortions are separable symptoms associated with neglect.

Prehension and perception of size in left visual neglect.

Right hemisphere damaged patients with and without left visual neglect, and age-matched controls had objects of various sizes presented within left or right body hemispace. Subjects were asked to estimate the objects' sizes or to reach out and grasp them, in order to assess visual size processing in perceptual-experiential and action-based contexts respectively. No impairments of size processing were detected in the prehension performance of the neglect patients but a generalised slowing of movement was observed, associated with an extended deceleration phase. Additionally both patient groups reached maximum grip aperture relatively later in the movement than did controls. For the estimation task it was predicted that the left visual neglect group would systematically underestimate the sizes of objects presented within left hemispace but no such abnormalities were observed. Possible reasons for this unexpected null finding are discussed.

Visual size processing in spatial neglect.

Evidence from the use of the landmark task and from two size-matching tasks shows that many patients with left-sided neglect systematically under-perceive visual extent in leftward parts of space. This perceptual distortion of size serves to explain the occurrence of rightward line-bisection errors in most neglect patients. One possibility is that attentional biases of a chronic nature might underlie these perceptual changes seen in neglect patients. But contrary to this idea, we have found that attentional cueing in the landmark task causes changes in neglect patients exactly opposite to those seen in healthy subjects. The distortions of size perception seen in neglect could instead be caused by a high-level alteration of visual processing rather than by an attentional bias. In order to explore which visual stream of cortical processing might be compromised in such a disorder, we have begun to examine neglect patients on visuomotor as well as perceptual tasks. We have found clear evidence in one patient for intact grip scaling for object size in the neglected half of space, despite gross perceptual underestimations of the same objects. This result suggests that neglect can occur without major disruption of the dorsal stream, and may result instead from damage to a cortical system whose predominant visual input comes from the ventral stream.

Coronary ostial stenosis.

Symptomatic, nonsyphilitic, acquired coronary ostial stenosis is a rare angiographic finding and was found in 0.13% of 3000 coronary angiograms. Three females with this lesion have been treated surgically. Two had left coronary ostial involvement. Coronary angiography may result in catheter tip occulsion of the ostium with chest pain, dyspnea, diaphoresis, systemic hypotension and abrupt fall in pressure at the catheter tip. Recognition of this entity is necessary for safe coronary angiography. Involvement of the left ostium carries the same serious prognosis as does left main coronary disease.