What exactly is extinguished in unilateral visual extinction? Neurophysiological evidence.

We propose a model of unilateral visual extinction following right hemisphere lesions based on competition between contralesional and ipsilesional input to access a decision centre located in the left hemisphere. During bilateral presentations, the contralesional signal is on average less likely to activate the decision centre than the ipsilesional signal. This is because an intra-hemispheric lack of top-down attentional influences and an inter-hemispheric impairment of callosal transmission delay and/or weaken the contralesional input. Here we provide behavioural as well as event-related potential evidence for both these impairments. Finally, we argue that an essential prerequisite for contralesional extinction is the presence of a restricted general attentional capacity which often follows large right hemisphere damage.