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There is a growing interest both in identifying the neural mechanisms of magnitude estimation and in identifying forms of bias that can explain aspects of behavioral syndromes like unilateral neglect. Magnitude estimation is associated with activation of temporo-parietal cortex in both cerebral hemispheres of normal subjects; however, it is unclear if and how left hemisphere lesions bias magnitude estimation because the infrequency of neglect and the presence of aphasia in these subjects confound examination. In contrast, we examined magnitude estimation using 12 different types of sensory stimuli that spanned five sensory domains in two patients with very different clinical presentations following unilateral left hemisphere stroke. One patient had neglect sub-acutely without aphasia. The other had aphasia chronically after a temporo-parietal lesion but not neglect. The neglect patient was re-examined 48 h after being treated with modafinil (Provigil) for decreased arousal. Both patients demonstrated bias in magnitude estimation relative to normal subjects (n=83). Alertness improved in the neglect patient after taking modafinil. His neglect also resolved and his magnitude estimates more closely resembled those of normal subjects. This is the first evidence, to our knowledge, that left hemisphere injury can bias magnitude estimation in a manner similar but not identical to that associated with right hemisphere injury.

Patients with right hemisphere injury frequently neglect to cancel targets primarily in the left part of the page nearest the body. Since this region is diagonally opposite the area from where such patients usually begin cancelling, near left ('diagonal') neglect may be consequent to stimulus order effects ('fatigue'). We evaluated the persistence of near left neglect in nine stroke patients when they had to cancel either the near or the far half of the page before proceeding to the other half. Our results showed that near left neglect on the page was largely unaffected by cancellation order. Furthermore, a near left gradient of omissions was established within both radial (near and far) halves of the page, as well as for the entire page. Our findings suggest that diagonal cancellation neglect is unrelated to fatigue and reflects a consistent, two-dimensional disorder of spatial attention. Such neglect may be related to the extent of the visible stimulus array, as well as to the array's location in egocentric space.

Women show menstrual phase-related cognitive changes that suggest altered hemispheric activation for a particular task, such that they demonstrate the greatest lateral performance differences on prototypical left hemisphere tasks during the luteal phase and on prototypical right hemisphere tasks during menstruation. Additionally, menstrual phase may alter total cerebral responsiveness, such that response times and performance accuracy for many tasks are best during the luteal phase and most impaired during the menstrual phase. We evaluated the effect of menstrual phase on spatial bisection (a perceptuospatial task) to help further understand hormonally-mediated changes in interhemispheric dynamics. Healthy young adult women and men blindly pointed to their midsagittal plane with either hand. Women were repeatedly tested according to menstrual phase, and men were tested at similar intervals. The mean pointing error in the luteal phase differed significantly from that of all other phases and did not differ significantly from those of men, who pointed significantly to the left across test sessions. These findings suggest that, in space bisection tasks, women are more likely to have asymmetric hemispheric activation during the luteal phase than during the menstrual phase. Thus, space bisection did not resemble other prototypical right hemisphere behaviors. The luteal phase may have nonspecifically activated both hemispheres on this task instead of suppressing right hemisphere function, and a slight functional asymmetry favoring the right hemisphere may have been promoted. In addition, intermanual pointing discrepancies in both subject groups decreased over repeated sessions. This suggests that, while practice alters an internal kinesthetic reference, it does not influence an imaginal extrapersonal spatial reference.