Visual Neglect (Hemispatial Neglect)

Visual neglect—often called hemispatial neglect or simply neglect—is a problem of attention and awareness, not a problem of eyesight itself. A person with visual neglect acts as if one side of space does not exist (most often the left side). The eyes can see and the nerves can carry signals, but the brain does not pay attention to one side. This usually happens after damage to the right side of the brain, especially the right parietal and temporoparietal areas, which are important for spatial attention. People may eat only food on one half of the plate, shave or apply makeup to only one side of the face, or bump into objects placed on the ignored side. Neglect can affect seeing, feeling, hearing, moving, and even the mental image a person holds in their mind.

Neglect is common after stroke but can also follow other brain injuries. It matters because it slows recovery, raises the risk of accidents, and reduces independence in everyday tasks. Early recognition and specific rehabilitation can make a strong difference.

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How neglect happens

The brain constantly filters and highlights the most important parts of the world around us—this is attention. The right parietal lobe and nearby networks (including the temporo-parietal junction, superior temporal gyrus, frontal eye fields, thalamus, and basal ganglia) help us map space, move our eyes and head to important things, and keep attention anchored. When these areas—especially on the right—are damaged, the brain’s built-in “spotlight” of attention swings away from the left. The left brain can still attend somewhat to both sides, but the right brain is especially important for attention to both sides; that is why right-sided injuries so often cause left-sided neglect.

Neglect is not the same as a visual field cut (hemianopia). In a visual field cut, the eyes and optic pathways cannot pass information from one half of the world. In neglect, information may reach the brain, but the brain does not use it. A person with neglect might turn their head or eyes away from the neglected side, fail to notice a person talking from that side, or miss items on that side even though their vision is technically capable of seeing them.

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Types of visual neglect

Neglect is a cluster of related problems. A person may have one type or several types together.

1. Space-based (egocentric) neglect
   The person ignores one side of their own space—usually everything to the left of their body’s midline. They do not turn their eyes or head to that side unless cued.

2. Object-based (allocentric) neglect
   The person misses the left half of individual objects, no matter where those objects are placed. For example, they read only the right half of each word or draw only the right half of a flower.

3. Personal neglect (body neglect)
   The person ignores the left side of their own body—for example, they do not shave, wash, or dress the left side.

4. Peripersonal neglect
   The ignored area is the space within arm’s reach. The person fails to attend to things on the left side of a table or desk.

5. Extrapersonal neglect
   The ignored area is the space beyond arm’s reach—for example, the left side of a room or hallway.

6. Motor neglect (premotor or intentional neglect)
   The person can see the left but fails to move the eyes, head, or limb toward the left. They may not reach for objects placed there unless strongly prompted.

7. Sensory neglect
   The person does not notice touch, sound, or visual items on the left side even when these sensations are present and measurable.

8. Tactile neglect
   Reduced awareness of touch on the left side of the body, even with normal skin sensation when tested alone.

9. Auditory neglect
   Reduced awareness of sounds coming from the left. The person may respond only to voices on the right.

10. Visual neglect
    Reduced awareness of visual items on the left side of space or the left side of objects.

11. Representational (imaginal) neglect
    The person’s mental image of familiar places or objects is missing the left side. If asked to imagine a known street, they may describe only buildings on the right.

12. Extinction
    A milder form: when a single left-side touch or light is presented, the person notices it; but when both sides are stimulated at the same time, the left is ignored (it “extinguishes”).

13. Viewer-centered vs. stimulus/object-centered neglect
    In viewer-centered neglect, the left of the viewer is ignored; in object-centered neglect, the left part of each object is ignored. People can have one or both.

14. Sustained attention deficits
    Trouble keeping attention over time, leading to more misses on the left as a task continues.

15. Reading-specific neglect (neglect dyslexia)
    The person omits the left parts of words or lines, causing reading errors and misunderstanding of text.

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Causes of visual neglect

1. Ischemic stroke in the right middle cerebral artery (MCA) territory
   A blood clot blocks a right-brain artery, injuring the parietal-temporal attention network; the person often shows left-sided neglect.

2. Intracerebral hemorrhage (bleeding) in right parietal or temporal lobes
   A burst blood vessel damages attention areas; swelling can worsen neglect.

3. Traumatic brain injury (TBI)
   A blow to the head can bruise or shear the right parietal or frontal regions, disrupting networks that turn eyes and attention to the left.

4. Brain tumor in right parietal, temporal, or frontal lobe
   Slow-growing or fast-growing masses can press on or destroy attention regions, causing gradual or sudden neglect.

5. Right thalamic stroke or hemorrhage
   The thalamus helps route attention signals; right-sided injury can lead to neglect or extinction.

6. Right basal ganglia lesions
   Damage to the caudate/putamen can disturb attention and movement planning toward the left.

7. Posterior cerebral artery (PCA) stroke with network disconnection
   When posterior brain areas and their connections to parietal/frontal networks are injured, neglect may appear.

8. White matter tract injury (e.g., superior longitudinal fasciculus damage)
   Even if the cortex is spared, damage to the wiring that links attention hubs can cause neglect.

9. Hypoxic-ischemic brain injury
   Global lack of oxygen (after cardiac arrest or severe hypotension) can injure attention networks, sometimes producing neglect.

10. Encephalitis (brain inflammation)
    Infections or autoimmune causes can inflame the right attention network, leading to neglect during the acute illness.

11. Brain abscess
    A localized infection in the right parietal or temporal lobe can disrupt spatial awareness.

12. Multiple sclerosis (MS) plaques
    Lesions affecting right parietal networks or connecting tracts may cause neglect-like symptoms.

13. Corticobasal degeneration (CBD)
    This neurodegenerative disease can combine motor problems with asymmetric cortical dysfunction, producing neglect or motor neglect.

14. Alzheimer’s disease and posterior cortical atrophy (PCA variant)
    When posterior right-hemisphere networks degenerate, people can show object-based neglect or reading-related neglect.

15. Epileptic seizures and post-ictal states
    After a seizure in right parietal/temporal regions, transient neglect or extinction can appear until the brain recovers.

16. Migraine aura with focal neurological deficits (rare)
    Complex migraine can cause temporary spatial attention problems that mimic neglect.

17. Post-neurosurgical changes
    Surgery near right parietal/temporal areas, or postoperative swelling, can cause temporary or permanent neglect.

18. Subdural hematoma on the right
    Blood collecting over the right hemisphere can compress attention areas and produce neglect, sometimes reversible after drainage.

19. Vasculitis (inflammation of brain blood vessels)
    When vessels supplying right-sided attention hubs become inflamed and narrowed, localized damage and neglect may result.

20. Toxic-metabolic encephalopathy with right-dominant dysfunction
    Severe systemic illness, electrolyte imbalance, or liver/renal failure can impair attention networks and worsen to neglect-like behavior, especially if superimposed on prior right-brain injury.

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Common symptoms and signs

1. Ignoring one side of space
   The person behaves as if the left side does not exist—objects on that side are not noticed unless someone redirects them.

2. Bumping into obstacles on one side
   While walking or using a wheelchair, the person frequently collides with door frames or furniture on the neglected side.

3. Eating from only one side of the plate
   Food on the left side is left untouched; the person may say they are done despite half the food remaining.

4. Grooming or dressing only one side
   Shaving, applying makeup, brushing hair, or putting on sleeves is done only on the right; the left side is forgotten.

5. Eyes and head turned to one side
   At rest, the eyes and head often deviate to the right, with little spontaneous scanning to the left.

6. Not noticing people speaking from the left
   The person turns toward voices on the right but ignores or delays responding to voices from the left.

7. Reading problems (neglect dyslexia)
   The person omits the beginnings of words or the left side of lines, causing confusion and mistakes.

8. Drawing only the right half of objects
   When asked to copy a clock or a flower, only the right half appears in the drawing.

9. Missing items during searches
   On a busy page or tabletop, the person fails to scan toward the left, leaving many items unfound.

10. Denial or limited awareness of the deficit (anosognosia)
    The person insists nothing is wrong and may deny difficulties, making safety and rehabilitation harder.

11. Extinction on double stimulation
    When both sides are touched or stimulated at the same time, the left is not perceived.

12. Poor navigation and spatial judgment
    Difficulty lining up a wheelchair, placing objects in the center, or navigating hallways without drifting right.

13. Slow or absent movement toward the neglected side (motor neglect)
    The person does not initiate movements into left space even though strength is adequate.

14. Problems with sustained attention
    Performance worsens over time during tasks that require searching or vigilance, especially for left-side items.

15. Safety risks
    High risk of falls, traffic accidents, kitchen injuries, and missed medical issues occurring on the left side.

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Diagnostic tests

Neglect is best diagnosed by bedside observation, paper-and-pencil tasks, and brain imaging. Tests help confirm neglect, measure its type and severity, and separate it from vision loss (hemianopia) or other problems.

A) Physical exam

1. Structured observation of spontaneous behavior
   The clinician watches how the person sits, looks, eats, grooms, and moves. Persistent rightward gaze/head turn, ignoring visitors on the left, and leaving food on the left side are strong clues.

2. Confrontation visual field testing with careful instructions
   The clinician checks each visual field one eye at a time to look for true visual field loss. If single left-side targets are seen but bilateral targets hide the left, that suggests extinction/neglect rather than hemianopia.

3. Double simultaneous stimulation (visual, tactile, auditory)
   The clinician presents stimuli to both sides at once (lights, touches, or tones). Failure to report the left-sided stimulus during simultaneous presentation is extinction, a key bedside sign of neglect.

4. Gaze and head-turn bias assessment
   The examiner asks the person to keep the head and eyes centered. A strong pull to the right or difficulty bringing gaze to the left suggests motor/intentional components of neglect.

5. Activities of daily living (ADL) observation
   Watching dressing, shaving/makeup, eating, and wheelchair use in a standardized way reveals personal, peripersonal, or extrapersonal neglect in real-life tasks.

B) Manual (paper-and-pencil or standardized bedside) tests

6. Line bisection test
   The person marks the middle of horizontal lines on paper. People with left neglect usually shift right, showing a consistent rightward bias.

7. Cancellation tests (stars, bells, letters, or lines)
   The person crosses out many small targets scattered across a page. Many left-side omissions indicate peripersonal neglect and poor leftward scanning.

8. Clock drawing / copying complex figures
   When copying a clock or a flower, the left side is thin or missing (e.g., numbers 1–6 crowded on the right). This shows object-based or viewer-based neglect.

9. Copying and gap detection in symmetrical shapes (allocentric tests)
   The person may miss left halves of shapes wherever they appear, flagging object-centered neglect.

10. Reading tests (neglect dyslexia screens)
    Skipping the left side of lines or the left halves of words suggests reading-specific neglect.

11. Baking Tray Task or “line crossing in space” tasks
    The person is asked to evenly place items across a tray or table. Clustering on the right and sparse placement on the left shows spatial neglect in reachable space.

12. Catherine Bergego Scale (CBS) or Behavioral Inattention Test (BIT)
    Standardized tools that record functional neglect in daily tasks and structured tests, providing a severity score to guide therapy.

C) Laboratory and pathological tests

13. Blood glucose and metabolic panel
    Finds low/high sugar, electrolyte imbalance, or other metabolic causes that worsen attention or mimic neglect—important in the acute hospital setting.

14. Complete blood count (CBC), coagulation profile, and inflammatory markers
    Looks for anemia, infection, clotting problems, or inflammation that may relate to stroke or hemorrhage risk.

15. Lipid panel and HbA1c (vascular risk workup)
    Identifies cholesterol abnormalities and diabetes control, key for understanding and preventing stroke—the most common cause of neglect.

Note: Lab tests do not “diagnose neglect,” but they explain causes and guide prevention and treatment.

D) Electrodiagnostic tests

16. Electroencephalography (EEG)
    Detects seizure activity or diffuse brain slowing that could worsen attention; rules out post-ictal states that can mimic neglect.

17. Evoked potentials (visual and somatosensory)
    Measures the brain’s electrical response to sights or touches. Normal early responses with poor awareness supports an attention problem rather than a sensory pathway failure.

E) Imaging tests

18. Non-contrast head CT ± CT angiography/perfusion (acute phase)
    Rapidly identifies bleeding or large ischemic stroke and shows vessel blockage and brain perfusion. Essential for emergency decisions.

19. MRI brain (DWI, FLAIR, susceptibility, perfusion)
    Shows acute infarcts, microbleeds, and structural damage in right parietal-temporal networks and their white-matter tracts. DWI detects fresh stroke; FLAIR shows tissue changes; susceptibility shows blood products.

20. Carotid ultrasound and transcranial Doppler
    Evaluates blood flow in neck and brain arteries to find narrowing or emboli sources related to stroke and neglect.

21. Functional imaging (task fMRI, SPECT, or FDG-PET)
    Demonstrates reduced activity in right attention networks or network disconnections even when structural scans look subtle, helping in complex or chronic cases.

Non-Pharmacological Treatments (therapies & others)

(Each includes description, purpose, mechanism in plain English)

1. Visual Scanning Training
   Description: Therapist teaches systematic left-to-right scanning with anchor cues on the far left margin.
   Purpose: Build a habit of checking the left side.
   Mechanism: Rewires attention networks through repetitive, guided eye and head movements.

2. Prism Adaptation Therapy
   Description: Wear right-shifting prism goggles while repeatedly pointing at left-placed targets; then remove goggles.
   Purpose: Reduce rightward bias and improve left awareness.
   Mechanism: Sensorimotor recalibration shifts the internal “straight-ahead,” strengthening leftward attention.

3. Limb Activation Therapy
   Description: Repetitively move, tap, or task the left arm/leg during activities.
   Purpose: Wake up motor attention to the left side.
   Mechanism: Movement on the left drives attention to that side via motor-attention coupling.

4. Optokinetic Stimulation (OKS)
   Description: View moving stripes or dots drifting leftward.
   Purpose: Pull gaze and attention toward the left.
   Mechanism: Automatic eye pursuit triggers leftward orienting.

5. Neck Muscle Vibration
   Description: Vibrate right neck muscles to influence perceived body midline.
   Purpose: Reduce rightward midline shift.
   Mechanism: Alters proprioceptive input to the brain’s body map, balancing spatial orientation.

6. Vestibular Stimulation (e.g., cold-water caloric)
   Description: Brief stimulation of the left ear canal by specialists.
   Purpose: Temporarily improves left awareness in some patients.
   Mechanism: Activates vestibular–parietal pathways that bias attention leftward.

7. Trunk Rotation Training
   Description: Physio guides controlled rotation of the trunk to the left during tasks.
   Purpose: Align body midline and reduce rightward bias.
   Mechanism: Adjusts egocentric reference frames used for attention.

8. Mirror Therapy
   Description: Use a mirror to view the reflection of the right limb as the left limb.
   Purpose: Encourage attention to the left side and improve motor intent.
   Mechanism: Visual feedback engages bilateral motor and parietal circuits.

9. Constraint-Induced Movement/Attention Training
   Description: Restrict tasks to require leftward use/search (safe, supervised).
   Purpose: Overcome learned non-use of the left side.
   Mechanism: Intensive practice strengthens underused networks.

10. Left Hemifield Patching / Sector Occlusion
    Description: Partial occlusion on glasses to block the right visual field.
    Purpose: Force attention and scanning to the left.
    Mechanism: Reduces competition from the right side so left signals get through.

11. Reading Rehabilitation (Anchors & Spacing)
    Description: Bold left margins, wider spacing, and left cueing lines.
    Purpose: Improve reading accuracy and speed.
    Mechanism: External cues guide eye movements into neglected space.

12. Environmental Restructuring
    Description: Place important objects, call bells, and visitors on the left; reduce clutter on the right.
    Purpose: Daily exposure trains leftward attention.
    Mechanism: Repeated leftward engagement forms stronger habits.

13. Auditory/Tactile Cueing
    Description: Sounds or gentle touch from the left during tasks.
    Purpose: Multisensory prompts pulling attention left.
    Mechanism: Cross-modal attention networks amplify left-side awareness.

14. Virtual Reality (VR) and Computer-Based Training
    Description: Gamified left-search tasks with real-time feedback.
    Purpose: Increase practice intensity and motivation.
    Mechanism: Adaptive difficulty promotes neuroplastic change.

15. Eye Movement/Saccade Training
    Description: Repeated fast eye jumps to the left toward targets.
    Purpose: Build automatic leftward orienting.
    Mechanism: Trains frontal eye fields and parietal systems.

16. Non-invasive Brain Stimulation: rTMS
    Description: Repetitive transcranial magnetic stimulation (specialist-delivered).
    Purpose: Reduce over-activity on the right side or boost left hemisphere to rebalance attention.
    Mechanism: Modulates cortical excitability and inter-hemispheric inhibition.

17. Non-invasive Brain Stimulation: tDCS/tACS
    Description: Low-level electrical currents via scalp electrodes during training.
    Purpose: Enhance learning from therapy.
    Mechanism: Slightly shifts neuronal resting potentials to favor plasticity.

18. Task-Specific OT/PT with Dual-Tasking
    Description: Combine left scanning with walking, reaching, or ADLs.
    Purpose: Carryover to real-world function.
    Mechanism: Context-specific practice improves generalization.

19. Caregiver Education & Safety Training
    Description: Teach family how to cue, place items, and set up rooms.
    Purpose: Reduce falls and frustration; speed recovery.
    Mechanism: Consistent external supports reinforce left attention habits.

20. Psychological Support & Motivation Strategies
    Description: Counseling, mood management, positive reinforcement, pacing.
    Purpose: Treat depression/apathy to engage in rehab.
    Mechanism: Better mood and motivation improve therapy intensity and outcomes.

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Drug Treatments

Important: Medication for neglect is adjunctive, often off-label, and should be supervised by a stroke/rehab specialist. Doses vary with age, kidney/liver function, interactions, and blood pressure/heart rhythm risks.

1. Methylphenidate (Stimulant; dopaminergic/noradrenergic)
   Dose/Time: 5–10 mg in the morning, titrate up to 20–30 mg/day in divided doses as tolerated.
   Purpose: Improve attention, processing speed, and therapy participation.
   Mechanism: Increases dopamine and noradrenaline in frontal-parietal attention circuits.
   Side effects: Insomnia, appetite loss, anxiety, ↑BP/HR; avoid with untreated arrhythmias.

2. Atomoxetine (Selective Norepinephrine Reuptake Inhibitor)
   Dose/Time: 40 mg/day, titrate to 80 mg/day; morning dosing.
   Purpose: Enhance sustained attention and reduce rightward bias.
   Mechanism: Boosts noradrenergic tone to the right parietal network.
   Side effects: Nausea, dry mouth, insomnia, rare liver issues; caution with hypertension.

3. Reboxetine (NRI; where available)
   Dose/Time: 4 mg twice daily; adjust to 8–10 mg/day.
   Purpose: Improve selective attention; support scanning therapy.
   Mechanism: Noradrenaline reuptake blockade in attention systems.
   Side effects: Dry mouth, constipation, insomnia, ↑HR/BP.

4. Guanfacine (α2A-adrenergic agonist)
   Dose/Time: 1 mg nightly → 2–3 mg/day as tolerated.
   Purpose: Strengthen prefrontal attention control; reduce distractibility.
   Mechanism: Enhances prefrontal network “signal-to-noise.”
   Side effects: Sedation, low BP, dizziness; avoid abrupt stop.

5. Bromocriptine (Dopamine agonist)
   Dose/Time: 1.25–2.5 mg/day → titrate cautiously.
   Purpose: Boost initiation and exploratory behavior to the left.
   Mechanism: Stimulates dopamine receptors aiding orienting.
   Side effects: Nausea, hypotension, hallucinations (rare), impulse issues.

6. Levodopa/Carbidopa (Dopamine precursor + decarboxylase inhibitor)
   Dose/Time: 62.5–125 mg levodopa (e.g., 100/25) 1–3×/day in trials.
   Purpose: Augment learning during therapy (timed before sessions).
   Mechanism: Increases dopamine to facilitate plasticity.
   Side effects: Nausea, dizziness, dyskinesia (uncommon at low trial doses).

7. Amantadine (Dopaminergic; NMDA antagonist)
   Dose/Time: 100 mg once-twice daily; adjust for kidneys.
   Purpose: Arousal, attention, initiation—useful after TBI and some strokes.
   Mechanism: Dopamine release + NMDA modulation.
   Side effects: Insomnia, ankle edema, livedo reticularis; lower seizure threshold.

8. Modafinil (Wake-promoting; dopaminergic/orexinergic)
   Dose/Time: 100–200 mg each morning.
   Purpose: Reduce fatigue, improve sustained attention.
   Mechanism: Increases cortical arousal networks.
   Side effects: Headache, anxiety, insomnia; drug interactions (CYP3A4).

9. Donepezil (Acetylcholinesterase inhibitor)
   Dose/Time: 5 mg nightly → 10 mg nightly if tolerated.
   Purpose: Support attention and learning with therapy.
   Mechanism: Boosts acetylcholine in attention circuits.
   Side effects: Nausea, vivid dreams, bradycardia; caution with heart block.

10. Galantamine or Rivastigmine (AChE inhibitors; choose one)
    Dose/Time: Galantamine 8–24 mg/day (divide); Rivastigmine 3–6 mg BID or patch 9.5 mg/24h.
    Purpose: Alternative cholinergic boost for attention/learning.
    Mechanism: Inhibits acetylcholinesterase; galantamine also modulates nicotinic receptors.
    Side effects: GI upset, weight loss, bradycardia; monitor.

Notes: Evidence strength varies by drug and study; benefits are often modest and largest when paired with active rehab (e.g., scanning, prism adaptation). Always individualize and monitor BP, heart rhythm, sleep, and mood.

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Dietary Molecular Supplements

Discuss with your clinician before starting; check for interactions (e.g., antiplatelets/anticoagulants). Typical adult ranges shown.

1. Omega-3 (EPA/DHA)
   Dose: 1–2 g/day combined EPA+DHA.
   Function: Supports neuronal membranes, anti-inflammatory.
   Mechanism: Incorporates into synaptic membranes; modulates cytokines.

2. Citicoline (CDP-choline)
   Dose: 500–2,000 mg/day (split).
   Function: Phospholipid precursor; may support attention/processing.
   Mechanism: Boosts phosphatidylcholine and acetylcholine synthesis.

3. Phosphatidylserine
   Dose: 100–300 mg/day.
   Function: Membrane support; may aid attention.
   Mechanism: Improves membrane fluidity and signaling.

4. Acetyl-L-Carnitine (ALCAR)
   Dose: 500–1,500 mg/day.
   Function: Mitochondrial energy; mental fatigue.
   Mechanism: Transports fatty acids into mitochondria; neurotrophic effects.

5. Coenzyme Q10 (Ubiquinone)
   Dose: 100–300 mg/day with food.
   Function: Cellular energy and antioxidant support.
   Mechanism: Part of electron transport chain; reduces oxidative stress.

6. Creatine Monohydrate
   Dose: 3–5 g/day.
   Function: Energy buffer for brain and muscle; may help therapy endurance.
   Mechanism: Replenishes ATP via phosphocreatine.

7. Magnesium (e.g., citrate/glycinate)
   Dose: 200–400 mg elemental/day.
   Function: Calms excitability; supports sleep and neuromuscular function.
   Mechanism: NMDA receptor modulation; cofactor in energy metabolism.

8. Vitamin D3
   Dose: 1,000–2,000 IU/day (or per blood level).
   Function: Neuroimmune and bone health; fall risk reduction.
   Mechanism: Nuclear receptor modulation; supports muscle function.

9. Vitamin B12 & Folate
   Dose: B12 500–1,000 mcg/day; Folate 400–800 mcg/day (adjust per labs).
   Function: Myelin and neurotransmitter synthesis; treat deficiencies.
   Mechanism: One-carbon metabolism; DNA and myelin support.

10. L-Theanine (with modest caffeine if tolerated)
    Dose: Theanine 100–200 mg; caffeine 25–100 mg.
    Function: Calm focus; may improve training quality.
    Mechanism: Increases alpha-wave activity; adenosine receptor interactions.
    Alternative botanical with caution: Ginkgo biloba 120–240 mg/day (bleeding risk with anticoagulants—ask your clinician first).

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Regenerative / Stem-Cell / Immunity-Booster” Drugs or Therapies

There is no approved “stem-cell drug” or immunity booster proven to treat visual neglect. The items below are experimental or niche; use only in clinical trials or specialist centers. Dosing varies by protocol and is not standardized for neglect.

1. Erythropoietin (EPO)
   Function: Neuroprotective and neurotrophic signals in some stroke studies.
   Mechanism: Anti-apoptotic, pro-angiogenic; may enhance recovery when combined with rehab.
   Dosage: Trial-dependent; not standard care for neglect.

2. G-CSF (Granulocyte Colony-Stimulating Factor)
   Function: Potential mobilization of progenitor cells; neuroprotective effects studied post-stroke.
   Mechanism: Increases circulating progenitors; trophic signaling.
   Dosage: Trial-dependent; not approved for neglect.

3. Cerebrolysin (peptide mixture; variable availability)
   Function: Claimed neurotrophic support; mixed evidence.
   Mechanism: Peptide spectrum mimicking neurotrophins; may aid plasticity with therapy.
   Dosage: Protocol-specific; off-label.

4. Autologous Bone-Marrow Mononuclear Cell Infusion
   Function: Experimental cell therapy after stroke.
   Mechanism: Paracrine trophic effects rather than engraftment.
   Dosage: Trial protocols only.

5. Mesenchymal Stem Cell (MSC) Therapy
   Function: Investigational for chronic stroke deficits.
   Mechanism: Anti-inflammatory and trophic cytokines; promotes plasticity.
   Dosage: Research-only.

6. Sovateltide (Endothelin-B receptor agonist; investigational)
   Function: Studied as a neuroregenerative agent in acute stroke.
   Mechanism: May stimulate neurogenesis and angiogenesis.
   Dosage: Trial-specific; not standard care.

Bottom line: These are not routine treatments for neglect. If you are interested, look for registered clinical trials and discuss risks/benefits with a stroke specialist.

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Surgeries

1. Mechanical Thrombectomy (acute ischemic stroke)
   Procedure: Catheter removes clot from large brain artery (e.g., right MCA).
   Why done: Restores blood flow quickly to save tissue and reduce severity of deficits, including potential neglect.

2. Carotid Endarterectomy or Stenting
   Procedure: Removes plaque or inserts a stent in a narrowed carotid artery.
   Why done: Prevent future right-hemisphere strokes that can worsen or trigger neglect.

3. Decompressive Hemicraniectomy
   Procedure: Temporarily remove part of skull to relieve brain swelling.
   Why done: Life-saving in “malignant” MCA stroke; preserves tissue for rehabilitation.

4. Aneurysm Clipping/Coiling or AVM Surgery
   Procedure: Secures bleeding source (hemorrhagic stroke).
   Why done: Prevent rebleeding or mass effect that injures attention networks.

5. Patent Foramen Ovale (PFO) Closure (selected young patients)
   Procedure: Catheter-based closure of heart shunt after thorough work-up.
   Why done: Reduce recurrent embolic strokes to the right hemisphere in carefully chosen cases.

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Preventions

1. Control blood pressure (target set by clinician).

2. Manage diabetes (glucose, HbA1c goals).

3. Treat high cholesterol (statins or alternatives as indicated).

4. Stop smoking and avoid tobacco exposure.

5. Treat atrial fibrillation (anticoagulation if indicated).

6. Use antiplatelet therapy after ischemic stroke/TIA as prescribed.

7. Mediterranean/DASH diet with less salt and processed foods.

8. Regular physical activity tailored to ability and safety.

9. Screen for sleep apnea and treat if present.

10. Home safety changes (good lighting, remove clutter, left-side cue placement).

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When to See Doctors

• Immediately (emergency): New weakness, numbness, face droop, trouble speaking, sudden severe headache, sudden vision or attention change—call emergency services right away (stroke).

• Urgent clinic: Worsening neglect, frequent falls, confusion, severe mood change, new seizures, side effects from medicines (palpitations, fainting, severe insomnia).

• Routine follow-up: Stroke clinic, neurology, physiatry (PM&R), occupational/physical/speech therapy, eye care (neuro-ophthalmology/optometry), primary care for risk factor control.

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What to Eat and What to Avoid

What to eat (support brain and heart health):

1. Leafy greens & colorful vegetables (spinach, kale, peppers).

2. Berries and citrus (antioxidant, vitamin C).

3. Whole grains (oats, brown rice, whole-wheat).

4. Legumes (lentils, beans) for fiber and minerals.

5. Lean proteins (fish—especially oily fish twice/week, poultry, tofu).

6. Nuts and seeds (walnuts, flaxseed, chia).

7. Olive oil as primary fat.

8. Low-fat dairy or fortified alternatives (calcium, D).

9. Plenty of water (hydration supports cognition, prevents delirium).

10. Herbs/spices (turmeric, garlic) for flavor with less salt.

What to avoid or limit:

1. Excess salt/sodium (worsens blood pressure).

2. Trans fats and partially hydrogenated oils.

3. Ultra-processed snacks high in sugar and sodium.

4. Sugary drinks and desserts (glucose spikes).

5. Excess alcohol; if used, keep minimal and only with clinician approval.

6. Grapefruit if taking interacting meds (statins, some others).

7. Large doses of unverified supplements without medical review.

8. Energy drinks (BP/heart rhythm risks).

9. Smoking/vaping (vascular harm).

10. Dehydration—set reminders to drink.

Frequently Asked Questions

1. Is neglect a vision problem?
   No. The eyes can be normal. Neglect is a brain attention problem that makes one side of space seem unimportant.

2. Why is left neglect more common?
   The right hemisphere monitors attention to both sides, so right-side injury leaves the left side unattended.

3. Can someone have both neglect and visual field loss?
   Yes. They can occur together and make navigation and reading more difficult.

4. How is neglect diagnosed?
   By bedside tasks (line bisection, cancellation), functional scales (CBS/BIT), and brain imaging to find the cause.

5. Will it get better?
   Many people improve in weeks to months, especially with rehab; some have lasting symptoms.

6. What therapy helps most?
   Prism adaptation and scanning training have good evidence; combining therapies and lots of practice works best.

7. Do medications cure neglect?
   No drug cures neglect. Some help attention and make therapy more effective. Use under specialist care.

8. Is non-invasive brain stimulation safe?
   rTMS and tDCS can be safe in trained hands with screening; benefits are modest and patient-specific.

9. Can I drive with neglect?
   Usually not early on. Driving requires full spatial awareness. You need formal assessment and your clinician’s approval.

10. What can family do at home?
    Place important items on the left, use verbal and visual cues, reduce clutter, and encourage left scanning during daily tasks.

11. How is neglect different from inattention or apathy?
    Neglect is directional (usually to the left) and affects how space is explored, not just overall motivation.

12. Does neglect affect reading and writing?
    Yes. People may skip left words or start writing in the middle/right of the page. Reading rehab can help.

13. What increases fall risk with neglect?
    Missing obstacles on the left, veering to the right, and poor insight (anosognosia). Therapy and home changes reduce risk.

14. Are stem cells a treatment now?
    No approved stem-cell therapy for neglect. Cell therapies are research-only at specialized centers.

15. What’s the single most useful daily habit?
    Deliberate left scanning with anchors (e.g., red line on the left margin) in every task—eating, reading, walking, grooming.

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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 30, 2025.