Classification images of two right hemisphere patients: a window into the attentional mechanisms of spatial neglect.

While spatial neglect most commonly occurs after right hemisphere lesions, damage to diverse areas within the right hemisphere may lead to neglect, possibly through different mechanisms. To identify potentially different causes of neglect, the visual information used (the 'perceptual template') in a cueing task was estimated with a novel technique known as 'classification images' for five normal observers and two male patients with right-hemisphere lesions and previous histories of spatial neglect (CM, age 85; HL, age 69). Observers made a yes/no decision on the presence of a 'White X' checkerboard signal (1.5 degrees ) at one of two locations, with trial-to-trial stimulus noise added to the 9 checkerboard squares. Prior to the stimulus, a peripheral precue (140 ms) indicated the signal location with 80% validity. The cueing effects and estimated perceptual templates for the normal observers showed no visual field differences. Consistent with previous studies of spatial neglect, both patients had difficulty with left (contralesional) signals when preceded by a right (ipsilesional) cue. Despite similar behavioral results, the patients' estimated perceptual templates in the left field suggested two different types of attentional deficits. For CM, the left template matched the signal with left-sided cues but was opposite in sign to the signal with right-sided cues, suggesting a severely disrupted selective attentional strategy. For HL, the left templates indicated a general uncertainty in localizing the signal regardless of the cue's field. In conclusion, the classification images suggested different underlying mechanisms of neglect for these two patients with similar behavioral results and hold promise in further elucidating the underlying attentional mechanisms of spatial neglect.