Images in… Taro Shimizu,1 Tomoya Abe,2 Yasutoshi Akasaki,2 Hideaki Kamiishi2 1 Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-­ gun, Tochigi, Japan 2 Department of Emergency Medicine, Tokyo-­West Tokushukai Hospital, Akishima, Tokyo, Japan Correspondence to Dr Taro Shimizu; ​shimizutaro7@​gmail.c​ om Accepted 29 October 2020 DESCRIPTION A 75-­year-­old woman presented with acute behavioural change. She was well until 6 hours prior, when she looked bizarrely while on cooking. Her son spoke to her and noticed that she was staring at her right side. He approached her from her left side and talked to her, but she did not seem to notice him as if she was ignoring him. In addition, the son also noticed that only the left half of the leeks laid out on the cutting board remained uncut. The right half of the leeks had already been cut and cooked in a pot of miso soup. Besides, she seemed that she could not find a salt jar, which was located to her left. Despite the fact that she faced difficulty in paying attention to her left side, she did not ask her son for help as she did not seem to be troubled by her situation. He thought something wrong was happening and Figure 2 MR angiography showed severe narrowing of brought her to the hospital. She had no fever, headache the proximal right middle cerebral artery. or weakness. On examination, she consistently turned her head and gaze to the right. She had no contralePatient’s perspective sional weakness. When instructed to point the middle of the stethoscope tube, she grabbed the right quarter Patient’s son: It was as if my mother could not see of the tube. Diffusion-­weighted MRI revealed high-­ the left half, or rather, she was ignoring it. intensity signals in the right inferior parietal lobule (figure 1); MR angiography showed severe narrowing Learning points of the proximal right middle cerebral artery (figure 2). She was diagnosed with unilateral spatial neglect due to ►► Patients with unilateral spatial neglect, caused acute ischaemic stroke. by the lesion in the inferior parietal lobule, Unilateral spatial neglect is characterised by sympsometimes present just with behavioural toms of not only ignoring the contralesional side but abnormalities. also being ipsilesionally attracted to stimuli.1 2 In the ►► Patients with ‘behavioural abnormalities’ are acute phase, the patient may show an ipsilesional devichallenging to examine. ation of the head and eyes.3 The damaged lesion is ►► An astute observation on the deviation of the typically located in the inferior parietal lobule region, head and eyes may lead to a rapid and accurate as in this case. Patients who present with behavioural diagnosis. abnormalities are challenging to examine, but an astute observation on the deviation of the head and eyes may lead to a rapid and accurate diagnosis. Contributors TS, TA, YA and HK created the manuscript, and TS revised the manuscript. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-­for-­profit sectors. Competing interests None declared. Patient consent for publication Obtained. Provenance and peer review Not commissioned; externally peer reviewed. © BMJ Publishing Group Limited 2020. No commercial re-­use. See rights and permissions. Published by BMJ. To cite: Shimizu T, Abe T, Akasaki Y, et al. BMJ Case Rep 2020;13:e239770. doi:10.1136/bcr-2020239770 REFERENCES Figure 1 Diffusion-­weighted MRI revealed high-­ intensity signals in the right inferior parietal lobule. 1 Mark VW, Kooistra CA, Heilman KM. Hemispatial neglect affected by non-­neglected stimuli. Neurology 1988;38:1207–11. 2 Chokron S, Peyrin C, Perez C. Ipsilesional deficit of selective attention in left homonymous hemianopia and left unilateral spatial neglect. Neuropsychologia 2019;128:305–14. 3 Gammeri R, Iacono C, Ricci R, et al. Unilateral spatial neglect after stroke: current insights. Neuropsychiatr Dis Treat 2020;16:131–52. Shimizu T, et al. BMJ Case Rep 2020;13:e239770. doi:10.1136/bcr-2020-239770 1 BMJ Case Rep: first published as 10.1136/bcr-2020-239770 on 23 November 2020. Downloaded from http://casereports.bmj.com/ on April 18, 2024 by guest. Protected by copyright. Unilateral spatial neglect Images in… Become a Fellow of BMJ Case Reports today and you can: ►► Submit as many cases as you like ►► Enjoy fast sympathetic peer review and rapid publication of accepted articles ►► Access all the published articles ►► Re-use any of the published material for personal use and teaching without further permission Customer Service If you have any further queries about your subscription, please contact our customer services team on +44 (0) 207111 1105 or via email at support@bmj.com. Visit casereports.bmj.com for more articles like this and to become a Fellow 2 Shimizu T, et al. BMJ Case Rep 2020;13:e239770. doi:10.1136/bcr-2020-239770 BMJ Case Rep: first published as 10.1136/bcr-2020-239770 on 23 November 2020. Downloaded from http://casereports.bmj.com/ on April 18, 2024 by guest. Protected by copyright. Copyright 2020 BMJ Publishing Group. All rights reserved. For permission to reuse any of this content visit https://www.bmj.com/company/products-services/rights-and-licensing/permissions/ BMJ Case Report Fellows may re-use this article for personal use and teaching without any further permission.