半耐心的忽视,无法关注空间的对侧,是视觉空间注意力最常见的干扰。半球忽略和视觉空间注意力通常都与扩展的皮层网络有关。然而,最近的报道挑战了这种所谓的皮质中心观点,并假设了远远超出端脑皮层的结构的参与,特别提倡脑干的作用。然而,据我们所知,尚未描述脑干病变后的半球忽略。我们描述,第一次在人类身上,右侧脑桥局灶性病变后,对侧视觉半侧忽视的发生和缓解。在免费的视觉探索过程中,通过视频眼图评估了半耐心的忽视,一种非常敏感和既定的方法,并随访其缓解,直到中风后三周。此外,通过病变缺陷方法辅以成像,我们确定了一种病理生理机制,涉及通过脑桥的小脑和/或大脑皮层-大脑皮层通路的断开。我们的发现提供,第一次在人类身上,因果关系,基于病变的支持,以最近的开创性陈述为基础,假定幕下结构在参与大脑皮层注意网络介导注意过程的活动中的作用。
Hemispatial neglect, the inability to attend to the contralesional side of space, is the most common disturbance of visuospatial attention. Both hemispatial neglect and visuospatial attention are typically associated with extended cortical networks. Nevertheless, recent accounts challenge this so-called corticocentric view and postulate the participation of structures well beyond the telencephalic cortex, in particular advocating the role of the brainstem. However, to the best of our knowledge, hemispatial neglect after a brainstem lesion has not yet been described. We describe, for the first time in a human, the occurrence and remission of contralesional visual hemispatial neglect after a focal lesion in the right pons. Hemispatial neglect was assessed by means of video-oculography during free visual exploration, a very sensitive and established method, and its remission was followed up until 3 wk after stroke. Moreover, by means of a lesion-deficit approach complemented by imaging, we identify a pathophysiological mechanism involving the disconnection of cortico-ponto-cerebellar and/or tecto-cerebellar-tectal pathways passing through the pons. Our findings offer, for the first time in a human, causal, lesion-based support for recent seminal accounts postulating the role of infratentorial structures participating in the activity of cerebral cortical attentional networks mediating attentional processes.NEW & NOTEWORTHY Visuospatial attention and its most common disturbance, hemispatial neglect, are typically associated with extended cortical networks. However, recent accounts challenge this corticocentric view and advocate the role of infratentorial structures. We describe, for the first time in a human, the occurrence of contralesional visual hemispatial neglect after a focal lesion in the right pons. We provide causal, lesion-based evidence for a pathophysiological mechanism involving the disconnection of cortico-ponto-cerebellar and/or tecto-cerebellar-tectal pathways passing through the pons.