What is the term for ignoring the entire affected side of the body after a cerebrovascular accident (CVA) with a fixed gaze to the opposite side?

Hemispatial Neglect Syndrome with Conjugate Gaze Deviation

The term for ignoring the entire affected side of the body after a cerebrovascular accident (CVA) with fixed gaze to the opposite side is "unilateral spatial neglect" or "hemispatial neglect syndrome" with conjugate gaze deviation. 1

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 (typically looking toward the right side when there is a right hemisphere lesion) and ignoring the contralateral (left) side of the body and environment 1
• 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

Anatomical Basis

• Hemispatial neglect most commonly results from damage to the right parietal lobe, particularly the region around the sulcus intraparietalis 2
• Other lesion sites that can cause neglect include the dorsolateral frontal lobe (premotor areas 8,9, and 46), anterior cingulate cortex, thalamus, and basal ganglia 2
• The condition reflects not only damage to specific anatomical regions but also large-scale dysfunction of networks involved in attention, motor, and multimodal sensory processing 3

Assessment

• The NIH Stroke Scale (NIHSS) evaluates extinction and inattention (neglect) in item 11, with scoring criteria:
  • 0 = No abnormality
  • 1 = Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one sensory modality
  • 2 = Profound hemi-inattention or extinction to more than one modality 4
• Testing and observation by a trained professional are necessary to distinguish neglect from visual field cuts, impaired attention, and planning or visuospatial abilities 1

Types of Neglect

• Egocentric neglect: neglect of information falling on the individual's contralesional side
• Allocentric neglect: neglect of the contralesional side of each object, regardless of the object's position in relation to the individual
• Interestingly, the same patient may exhibit egocentric neglect in one task and allocentric neglect in another, depending on task demands 5

Clinical Significance and Prognosis

• 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
• 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

Treatment Approaches

• 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 1, 6
• 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 (though evidence is insufficient to make a definitive recommendation) 1, 6
  • Half-field eye patching (though evidence is insufficient to make a definitive recommendation) 1, 6
  • Limb activation techniques 6
  • Non-invasive brain stimulation methods such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) 7

Important Clinical Considerations

• 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 6

Hemispatial neglect syndrome with conjugate gaze deviation represents a complex attentional disorder rather than a primary sensory or motor deficit, requiring specialized assessment and a comprehensive rehabilitation approach focused on improving awareness and functional outcomes 1, 8.