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The Journal of Neuroscience, April 11, 2007, 27(15):4045-4051; doi:10.1523/JNEUROSCI.0041-07.2007

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Neurobiology of Disease
Anatomical Correlates of Directional Hypokinesia in Patients with Hemispatial Neglect

Ayelet Sapir,¹ Julie B. Kaplan,⁴ Biyu J. He,¹ and Maurizio Corbetta^1,2,3

Departments of ¹Neurology, ²Radiology, and ³Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, Missouri 63110, and ⁴Department of Psychology, Washington University, St. Louis, Missouri 63110

Correspondence should be addressed to Ayelet Sapir, Department of Neurology, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO 63110. Email: ayelet{at}npg.wustl.edu

Unilateral spatial neglect (neglect) is a syndrome characterized by perceptual deficits that prevent patients from attending and responding to the side of space and of the body opposite a damaged hemisphere (contralesional side). Neglect also involves motor deficits: patients may be slower to initiate a motor response to targets appearing in the left hemispace, even when using their unaffected arm (directional hypokinesia). Although this impairment is well known, its anatomical correlate has not been established. We tested 52 patients with neglect after right hemisphere stroke, and conducted an anatomical analysis on 29 of them to find the anatomical correlate of directional hypokinesia. We found that patients with directional hypokinesia had a lesion involving the ventral lateral putamen, the claustrum, and the white matter underneath the frontal lobe. Most importantly, none of the patients without directional hypokinesia had a lesion in the same region. The localization of neglect's motor deficits to the basal ganglia establishes interesting homologies with animal data; it also suggests that a relative depletion of dopamine in the nigrostriatal pathway on the same side of the lesion may be an important pathophysiological mechanism potentially amenable to intervention.

Key words: anatomy; attention; basal ganglia; fMRI; motor; neglect; stroke

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Received July 12, 2006; revised Feb. 15, 2007; accepted Feb. 19, 2007.

Correspondence should be addressed to Ayelet Sapir, Department of Neurology, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO 63110. Email: ayelet{at}npg.wustl.edu

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