Spatial Attention
Neglect and extinction localizer
Separate hemispatial neglect from field loss by looking at search strategy, object-centered distortion, extinction under competition, and the mismatch between what the patient can detect alone versus what they explore spontaneously.
Clinical presets
Attention failure is not one syndrome
Choose whether the dominant problem is viewer-centered bias, bilateral extinction, object-centered truncation, or leftward motor initiation failure.
Attention map
Exploration field under the current syndrome
Line bisection
Midpoint is dragged rightward
Large shifts point toward viewer-centered spatial bias even when formal strength and primary sensation are intact.
Competition load
Bilateral input suppresses the left side
Extinction is exposed by comparing single-target detection with bilateral competition, not by single-item confrontation alone.
Phenotype
Classic right parietal neglect
Dense left hemispatial neglect with rightward exploration bias, left extinction, and a large line-bisection shift.
Left target capture
17%
How many leftmost cancellation targets are spontaneously acquired.
Center capture
67%
Center-space can stay partly intact even while left exploration collapses.
Bisection shift
+18%
Rightward midpoint bias is a compact readout of egocentric spatial pull.
Extinction load
82%
Higher values mean bilateral competition is disproportionately destructive.
Strongest localization
Network before lesion label
Right inferior parietal lobule and temporoparietal junction within the ventral attention network.
The right-lateralized attention network normally surveys both hemispaces. When it fails, intact left-hemisphere orienting is no longer balanced and search collapses rightward.
Weaker alternative
Why a field cut is not enough
A pure left homonymous hemianopia is weaker because neglect also distorts search strategy, extinction, copying, and awareness rather than just removing left visual input.
Discriminators
What to look for at the bedside
- Cancellation starts on the right edge and never fully sweeps left.
- Double simultaneous stimulation worsens left awareness far more than single-item testing.
- Clock drawing and scene copying are spatially imbalanced rather than uniformly degraded.
Bedside probes
Tasks that reveal the syndrome layer
Star cancellation
Leftmost targets are skipped despite adequate time and intact rightward search.
Points to exploratory-attention failure rather than isolated acuity loss.
Line bisection
Marked midpoint is shifted well to the right of center.
Captures egocentric spatial bias quickly at the bedside.
Double simultaneous stimulation
Left touch is detected alone but disappears when the right side is stimulated simultaneously.
Supports extinction layered on top of neglect rather than a dense primary sensory deficit.
Supportive strategy
Rehab and teaching moves
- Anchor all reading and search tasks to a bright left-edge cue.
- Train deliberate leftward scanning before increasing task speed.
- Orient meals, call bells, and teaching prompts into the neglected hemispace on purpose.
Continue the loop
Pair attention with fields, cortex, stroke, and tutoring
Visual Field Localizer
Consult-level visual localization
Visual Cortex
Consult-level cortical vision reasoning
Brain Atlas
Post-clinical anatomical convergence
Stroke Vascular Territories
Acute neurovascular localization
Neuro Tutor
Cross-module consult reasoning with explicit scoring