190

Journal of Tongji Medical University
[~ ~ ~ ~ ~: q~.~ ~ ( ~1,~: ~ ) 18(3): 190-192, 1998

Neglect and Constructive Disorder
SHI Qijia (~j~t4~)
Department of Neurology, Tongji Hospital, Tongfi Medical University, Wuhan 430030
Feng Jianhua ( ~ )
"
Red Cross Hospital, Qinhai 810000
YANG Ming ('1~ ejt:)
Local Hospital, Xinyang , Henan 464100
CHANG Liying ( ~ ~ ~ )
Department of Neurology, Central Hospital, Xiangfan, Hubei 441021

Summary: A 61 year-old right handed man, who suffered from right cerebral infarction with evidences of visual-spatial neglect and constructive disorder, was reported. When copying simple geometric designs, he omitted to copy figures on the
left side of the page; he tended to bisect the line to the right of the line's real center; after memorizing the familiar pictures he mainly mentioned the pictures on
the right side of the page; when cupying the "Rey Complex" he also ignored the
structures on the left side. The relations of the neglect and construction disorder
are discussed.
Key words : neglect ; constructive apraxia ~ visual-spatial disorder

1

CASE R E P O R T

A sixty-one years-old man was admitted because of left limbs weakness for 2
days. T h e patient, had the sudden tumbling
without headache and loss of consciousness,
and soon he developed left limb weakness
and dysarthria.
With unilateral gazing to the right
side, the patient's head was toward to the
right on examination. He had left facial,
tongue and limbs palsy ( s t r e n g t h : 0 / 5 ) .
Cranial C T showed the cerebral infarction in
the dominant area of the right hemisphere.

nored (the ignored lines were all located in
the left visual field of the patient).

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Fig. 1 The Line Bisection Test
2

RESULTS

2. 1

Aphasia Examination
Aphasia T e s t developed by the affiliated hospital of Beijing Medical University
was conducted in the first week after onset
and no aphasic s y m p t o m s were found.
2 . 2 Visual Neglect Examination
2. 2. 1 The Line Bisection Test r2]
T h e result was 2C14R (fig. 1 ) , e . g . the written
lines were 14 times inclined to the right
sides, 2 times at the middle and 4 times igSHI "Qijia, male, born in 1964, Associate Professor

2. 2. 2 Vernea Test E21
T h e patient was
asked to fulfilled the three " X " into a box.
He showed a tendency of right fulfilling
(fig. 2)
2. 2. 3 Writing Ability Examination
His
writing was normal (fig. 3).
2. 2. 4 Meaning Pictures Recall Test
The
pictures the patient recalled w e r e : s t a r ,
clock, a r r o w , question m a r k , raining and
smile face (fig. 4 ) .
2. 2. 5 Description of Symmetric Picture
T h e patient identified 6 windows in the
right side, 12 in the left sides and he painted a arrow on the right side (fig. 5).

SHI Qijia et al. Neglect and Constructive Disorder

191

Fig. 2 Vernea test

Fig. 3 The patient's writing

Fig. 4 Meaning Pictures Recall Test

Fig. 5 Decription of symmetric pictures

2. 3

Constructive Test
Rey Complex Figure E23 was employed
and the patient's score was 7 (normal score

Fig. 6

is 36). The structures on the left side were
ignored (fig. 6).

Rey complex figure and patient's presentation
2. 4

Match Test and Tri-dimentional Test
The patient failed to perform the
" M a t c h T e s t " and "Tri-dimentional T e s t "
(fig. 7).

3

Fig. 7

"Match Test" and "Tri-dimentional
Test"

DISCUSSION

"Visual-spatial neglect S y n d r o m e " was
defined first by Oppenheimer ( 1 8 8 3 ) and
Holmes E~J as the phenomenon of " n e g l e c t "
or " i g n o r a n c e " to the contralateral visual
stimulus of the brain lesion side. Clinically,

192

Journal of Tongji Medical University 18 (3): 190-192, 1998

the patients with the lesion on the right
hemisphere showed no responses or postponed reaction to the stimulus coming from
the contralateral side of visual field, which
were also defined as "agnosia of opposite
half of s p a c e ' . This was verified in our ease
by Line Bisection Test (fig. 1 ) , Vernea
Test (fig. 2 ) , Meaning Pictures Recall Test
(fig. 4 ) , and symmetrie picture Describing
Test (fig. 5). It was believed, that the lesion involving the right frontal, temporal
and central lobes could result in neglect,
the real neglect was in close relation to the
lesion of the central lobe of the non-dominant hemisphere, although the neglect was
seen after central lobe onset in the dominant
hemisphere c~3, According to the Battersby's
review, 33 % patients with the neglect had
lesions located in the temporal and central
lobes of the non-dominant hemisphere,
whereas 20 ~ were located in the frontal
and central lobes. Mesulam suggested that
the oeular motor abnormality in relation to
the frontal lesion presented the obst~icle to
the contralateral visual field scanning, socalled "automatic attention diminishment"
(frontal neglect) c~3. Our case showed unilateral gazing to the right side, with the lesions in the right hemisphere, and the gazing was soon improved after one week. So
his neglect could be the real neglect.
T h e patient had constructive problems.
He failed to complete Rey complex test,
Match T e s t and the three-dimensional test.
The phenomena was described as "Construetive a p r a x i a " , a combined disorder of
sensation-motor reaction involving the central lobe. Dee reported 42 cases of visualspace disorders among 46 patients with con-

structive apraxia [4].
While our case had severe neglect and
constructive s y m p t o m s , his writing ability
was preserved (fig. 3 ) , with up-deviation
from left to right side. It was described by
W a n g , that the visual-spatial writing disorder of Chinese patient was caused by the
thalamus and central or occipital lobes lesions o f the non-dominant hemisphere E61. It
is said, that the Chinese characters are integrated in both hemispheres, and since the
left hemisphere of our case was preserved,
his symptoms improved after one week, so
the constructive related agraphia was not
presented by our ease. Our case suggested
that the Chinese patients would have a good
outcome of their visual-spatial disorder, as
the Chinese characters are built constructively. By the same t o k e n , Chinese agraphia
may get better prognosis, since the Chinese
scripts are thought to be integrated bilaterally.
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~-~.
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~'~~',~.
,~ ,1986,19.. 109
(Received July 10, 1997)