Note

Expert Note Case 6.

Unbuttoned

This patient demonstrates several aspects of left-sided neglect. In addition, he seems to have lost an understanding of 3-D spatial concepts in general, as exemplified by his inability to button his shirt or put on gloves correctly (dressing apraxia).  The precise localization of his problem is not known, but often the posterior parts of the parietal and temporal lobes are involved. His face and speech indicate little emotion, but it is difficult to know whether he is unconcerned by his deficit, or is unable to express emotion through facial expressions or intonation as a result of the stroke. The incomplete homonymous hemianopsia is produced by damage to some of the fibers in the visual radiations that run through this region. The primary motor and somatosensory cortex, which tends to lie in the territory of superior MCA branches, was ultimately spared in this patient. However in the acute phase of his stroke he showed some facial weakness because of brain swelling that affected the functioning of the motor cortex.