Hemispatial neglect is a neuropsychological condition in which, after damage to one hemisphere of the brain (e.g. after a stroke), a deficit in attention and awareness towards the side of space opposite brain damage (contralesional space) is observed. It is defined by the inability of a person to process and perceive stimuli towards the contralesional side of the body or environment. Hemispatial neglect is very commonly contralateral to the damaged hemisphere, but instances of ipsilesional neglect (on the same side as the lesion) have been reported.
Presentation Hemispatial neglect results most commonly from strokes and brain unilateral injury to the right cerebral hemisphere, with rates in the critical stage of up to 80% causing visual neglect of the left-hand side of space. Neglect is often produced by massive strokes in the middle cerebral artery region and is variegated, so that most sufferers do not exhibit all of the syndrome's traits. Right-sided spatial neglect is rare because there is processing of the right space by both the left and right cerebral hemispheres, whereas in most left-dominant brains the left space is only processed by the right cerebral hemisphere. Although it most strikingly affects visual perception ('visual neglect'), neglect in other forms of perception can also be found, either alone or in combination with visual neglect. For example, a stroke affecting the right parietal lobe of the brain can lead to neglect for the left side of the visual field, causing a patient with neglect to behave as if the left side of sensory space is nonexistent (although they can still turn left). In an extreme case, a patient with neglect might fail to eat the food on the left half of their plate, even though they complain of being hungry. If someone with neglect is asked to draw a clock, their drawing might show only the numbers 12 to 6, or all 12 numbers might be on one half of the clock face with the other half distorted or blank. Neglect patients may also ignore the contralesional side of their body; for instance, they might only shave, or apply make-up to, the non-neglected side. These patients may frequently collide with objects or structures such as door frames on the side being neglected. Neglect may also present as a delusional form, where the patient denies ownership of a limb or an entire side of the body. Since this delusion often occurs alone, without the accompaniment of other delusions, it is often labeled as a monothematic delusion. Neglect not only affects present sensation but memory and recall perception as well. A patient suffering from neglect may also, when asked to recall a memory of a certain object and then draw said object, draw only half of the object. It is unclear, however, if this is due to a perceptive deficit of the memory (to the patient having lost pieces of spatial information of the memory) or whether the information within the memory is whole and intact but simply being ignored, the same way portions of a physical object in the patient's presence would be ignored. Some forms of neglect may also be very mild—for example, in a condition called extinction where competition from the ipsilesional stimulus impedes perception of the contralesional stimulus. These patients, when asked to fixate on the examiner's nose, can detect fingers being wiggled on the affected side. If the examiner's fingers were wiggled on both the affected and unaffected sides of the patient, the patient will report seeing movement only on the ipsilesional side.
Language and communication impairments Although hemispatial neglect is most commonly described as a visuospatial disorder, research shows that it also produces systematic impairments in language comprehension, reading, writing, inference, and discourse-level processing. These deficits arise because neglect reduces attention to information presented on the left side of space, the left side of visual words and sentences, and the left side of communicative scenes or narratives.
Neglect dyslexia Neglect often causes characteristic reading errors, sometimes termed neglect dyslexia or hemispatial dyslexia. Individuals may read only the right portion of words or sentences, omit initial letters, or substitute right-side components for full items. For example, a patient may read “Whitehouse” as “house,” or read only the final words on each line of text. These errors show impaired distribution of visuospatial attention to the left hemifield rather than deficiencies in phonology or semantics. Neglect dyslexia improves when text is shifted toward the right visual field. This further demonstrates its dependence on spatial attention rather than linguistic ability.
Neglect dysgraphia Writing may also be affected. Patients frequently confine their writing to the right side of the page, omit leftward characters, or fail to complete words extending into the neglected hemispace. In dictation tasks, the left margin often collapses, with text drifting progressively rightward. These errors signal spatial bias and often improve as attentional deficits recover. Patients may also show difficulty placing words or maintaining spatial layout on a page, consistent with disruption of visuospatial attention.
Discourse comprehension and inferencing Hemispatial neglect and right hemisphere damage can impair higher-level language functions that require integrating information across a narrative, picture, or conversational context. Individuals may fail to incorporate critical cues that appear on the left side of these contexts, leading them to misinterpret events. Their narrative descriptions often focus disproportionately on right-sided details. Sentence-level linguistic abilities are preserved, making it clear that the deficit lies in integrating context, not in language itself. Narrative performance commonly shows reduced coherence and difficulty integrating themes or connecting events, proving right-hemisphere functions in managing discourse.
Pragmatic and communicative difficulties Neglect can affect how people use language in conversation, making it harder to take turns, stay on topic, or draw on shared context. They may give descriptions that are too brief and miss important left-sided details, or they may talk only about the right-side elements. Combining spatial and contextual cues during communication is more difficult for these individuals. Note that basic language abilities remain intact.
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