Frontal lobe neglect in man

Abstract

American Academy of Neurology Dedicated to advancing the art and science of neurology, and thereby promoting the best possible care for patients with neurological disorders A Celebration of the First 50 Years of the American Academy of Neurology Neurology 1972;22:660-664 █ My hypothesis is that the frontal lobes are the seat of coordination and fusion of the incoming and outgoing products of the several sensory and motor areas of the cortex. Bianchi (1895)1 made this hypothesis after excising the frontal lobes in animals and observing rotary movements to the side of the lesion and a visual disturbance that appeared as a contralateral hemianopia. Kennard2 showed that there was also a loss of cutaneous sensitivity in these animals, and Kennard and Ectors3 proposed that the visual defect was more a hemianopia in which an object is disregarded than a true hemianopia. Welch and Stuteville4 found that with lesions of the posterior part of the superior limb of the arcuate sulcus, their monkeys had unilateral neglect to all sensory modalities tested. Although many investigators have produced and described frontal neglect in monkeys, unilateral frontal neglect has not been described in man other than in the two cases of pseudohemianopia described by Halstead5 and Thiebaut.6 The purpose of this study was to assess patients with frontal lobe lesions to establish the presence of unilateral neglect-hemispatial agnosia, inattention, and extinction to simultaneous stimuli-and to relate these findings to other known phenomena attributed to frontal lobe disease. Patients admitted to the University of Florida Teaching Hospital or Boston City Hospital during 1969 and 1970 who demonstrated lesions confined to the frontal lobes, as demonstrated by brain scan or postmortem examination, were included in this series. Six cases of unilateral neglect were uncovered (seetable). The anatomic loci of the …