Hemispatial neglect — MRCPsych Paper A MCQ

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ModerateNeuroanatomyHemispatial neglectMRCPsych Paper A

Following a right hemispheric stroke, a 75-year-old woman consistently leaves food on the left half of her plate despite intact primary visual fields. She has left-sided weakness but insists that her left arm is functioning normally. Damage to which brain structure best accounts for this presentation?

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Correct answer: C — Right inferior parietal lobule

The correct answer is C, the right inferior parietal lobule. Failure to attend to food on the left despite intact primary visual fields indicates left hemispatial neglect rather than hemianopia. Her denial of established left-arm weakness is anosognosia, which commonly accompanies right parietal network injury. The right, usually non-dominant, inferior parietal region is central to spatial attention directed toward both sides of space; its damage therefore particularly produces left neglect. A right primary visual cortex lesion causes left homonymous hemianopia rather than neglect. A left inferior parietal lesion would more typically produce dominant-hemisphere deficits and, if neglect occurred, right-sided neglect. A right primary motor cortex lesion explains weakness but not neglect or anosognosia. Hippocampal damage primarily impairs memory.

Reference: Verdon V, Schwartz S, Lovblad KO, Hauert CA, Vuilleumier P. Neuroanatomy of hemispatial neglect and its functional components: a study using voxel-based lesion-symptom mapping. Brain. 2010;133:880–894. https://elearninghub.rcpsych.ac.uk/catalog?pagename=Paper_A_mapping