Cerebral hemiatrophy is a rare neurological condition, usually resulting in severe and diffuse cognitive impairment. In this paper we present a 69-year old woman with notable congenital hemiatrophy with strikingly preserved cognitive functions. Cognitive assessment indicated that although her executive functions were found impaired, the remaining cognitive domains were relatively unaffected. We argue that this unexpected cognitive profile may be explained by anomalous hemispheric lateralization, driven by neuroplasticity along the developmental course.

Spatial neglect is a frequent, disabling syndrome and is associated with a poor rehabilitation outcome. Return to work seems almost impossible and has not been reported so far. Here, three cases with extensive right-hemisphere lesions after stroke are reported, who all showed residual left visuospatial neglect, left visual extinction on double simultaneous stimulation (DSS), and marked spatial-perceptual deficits. After early inpatient rehabilitation all three patients received specific, successive neuropsychological therapy as outpatients in four domains: (1) Optokinetic stimulation with pursuit eye movements and saccadic eye-movement training to reduce left-sided neglect and improve visual exploration; (2) Anti-extinction training to reduce left-sided visual extinction; (3) Spatial-perceptual feedback training to improve spatial-perceptual disorders and visuoconstruction; and (4) Job-related visual and cognitive treatments. All three cases were treated in sequential single-subject baseline designs. Significant improvements were obtained in all treated domains during therapy, which persisted at follow up. After a period of graded vocational re-integration, all three patients worked successfully in their prior job, two part-time (50%), one full-time (100%). These results show that return to professional (paid) work is possible despite initially severe neglect, hemianopia, visual extinction, and spatial-perceptual disorders after stroke.

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