1. Neurology Resident and Fellow Section
Posterior Territory Stroke with Parahippocampal Involvement: A neglected Cause of Neglect
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2018 American Academy of Neurology

2. Vignette
87-year old man
Presented with a stroke in the right posterior territory
At first, he was thought to have a left homonymous hemianopia
Which was discovered to be a visual neglect upon further testing
Maaijwee et al.
© 2018 American Academy of Neurology

3. Video
1: Head turned right: Patient reads headline on left side of page.
2: Head and trunk aligned: Patient reads article on right side of page. Despite asking explicitly to read article on left side of page, he cannot find it.
3. Head turned right: patient quickly recognizes previously read headline.
Maaijwee et al.
© 2018 American Academy of Neurology

4. Imaging
Brain-MRI: DWI-Sequence (left) and ADC-Sequence (right), showing a stroke in the right posterior cerebral artery territory involving the parahippocampal gyrus (see arrow)
Maaijwee et al.
© 2018 American Academy of Neurology

5. Posterior territory stroke with parahippocampal involvement: A neglected cause of neglect
The tip of the occipital lobe was spared and therefore complete hemianopia is not to be expected
Visual neglect is common with parahippocampal gyrus involvement
Hemianopia and visual neglect can be tested for separately, by turning the body of the patient to the left and his head to the right, because the neglect is body centered
References:
Mort DJ MP, Mannan SK, Rorden C, Pambakian A, Kennard C, Husain M. The Anatomy of Visual Neglect. Brain 2003;126:
Nyffeler T PR, Hopfner S, Job O, Nef T, Pflugshaupt T, Vanbellingen T, Bohlhalter S, Müri RM, Kerkhoff G, Cazzoli D. Contralesional Trunk Rotation Dissociates Real vs. Pseudo-Visual Field Defects due to Visual Neglect in Stroke Patients. Frontiers in Neurology 2017;8:411.
Maaijwee et al.
© 2018 American Academy of Neurology