Exploring the syndrome of spatial unilateral neglect through an illusion of length

Both a neuropsychological syndrome (unilateral spatial neglect) and a visual illusion of length (the Brentano version of the Müller-Lyer illusion) bring about a misjudgement of the subjective centre of a horizontal line, with a unilateral shift. In experiment 1 we investigated, in patients with left unilateral neglect, illusory effects of horizontal length, with the aim of exploring the functional and neural basis of horizontal space perception, and the role of visual processing in shaping the patients' bisection performance. Fourteen right-brain-damaged patients with left spatial unilateral neglect, seven with and seven without left visual half-field deficits (assessed by confrontation, perimetry, and visual event-related potentials), entered this study. Two conditions of manual line bisection were assessed: setting the mid-point of a horizontal line, and of the shaft of the Brentano-Müller-Lyer illusion, with either a left- or a right-sided expansion. Both groups of patients set the subjective midpoint to the right of the objective centre of the line, consistent with the presence of left neglect. Patients with neglect and left hemianopia showed no illusory effects and a greater bisection error. The effects of the illusion, by contrast, were fully present in neglect patients without hemianopia, in both illusory conditions, adding to, or subtracting from, the rightward bisection bias. Anatomoclinical correlations revealed an association of damage to the occipital regions with the lack of illusory effects. Conversely, more anterior damage, sparing these regions, did not disrupt the illusion, revealing a dissociation between visual and spatial processing of extension. These findings suggest that processing of the Müller-Lyer illusion of length is likely to occur in the occipital cortex, at a retinotopic level of representation. In neglect patients with left homonymous hemianopia the visual deficit adds to the spatial bias, yielding a greater error in line bisection, but not in other visual exploratory tasks, such as cancellation, where the contribution of retinotopic frames is likely to be comparatively minor. Experiment 2 showed preserved illusory effects in patients with homonymous visual field defects without spatial unilateral neglect, suggesting that preserved spatial processing may compensate for unilateral visual field defects.