A Case of Unilateral Spatial Neglect and Impaired Dorsal Attention Network Function Due to Acute Subcortical Hemorrhage: Focusing on Endogenous Attention While Walking

Unilateral spatial neglect is a higher-level cognitive disorder characterized by difficulty perceiving or responding to stimuli in the contralateral space due to lesions in the cerebral hemisphere. Presently, there are clinical challenges in the assessment of and intervention for unilateral spatial neglect. First, assessments and interventions are often conducted under static conditions, such as sitting, which can lead to discrepancies in the symptoms observed during daily activities, such as walking. Second, although unilateral spatial neglect affects both the peripersonal and extrapersonal space domains, conventional interventions have mainly targeted the peripersonal space domain, with insufficient attention to the extrapersonal space domain. In this case report, we aimed to present a case in which we evaluated walking conditions, using a treadmill, and an endogenous attention task targeting the extrapersonal space domain, using a laser pointer, in a 50-year-old male with a hemorrhage in the right superior parietal lobe. The evaluation revealed discrepancies between seated and walking conditions. Following the intervention, the participant's attention span toward the left side improved during walking, and walking ability increased after 5 days. The intervention continued, and the participant was discharged 1 month after the onset of cerebral hemorrhage. This suggests that evaluations and interventions targeting extrapersonal spaces under dynamic conditions that are more closely aligned with daily life may be effective for symptom improvement, addressing issues that cannot be fully captured by desk-based tests alone.