Left size distortion (hyperschematia) after right brain damage

Objective: To quantitate a size distortion involving the side of space contralateral to the lesion (contralesional) in two right-brain-damaged patients. Methods: We studied two right-brain-damaged patients with lesions sparing the occipital lobe and a mild left neglect on target cancellation or line bisection. The lesions involved the temporoparietal region ( Patient 1) and the basal ganglia and the insula (Patients 1 and 2). Patients were given drawing tasks and tasks requiring perceptual and visuomotor judgments of horizontal extent. Results: In drawing objects such as a daisy both from memory and by copying, patients exhibited a disproportionate enlargement of the left-hand side of objects and added more left-sided petals to the drawn daisy. This pathologic behavior persisted when the patients were blindfolded and was likely to reflect a perceptual, rather than premotor, size distortion. In a task requiring the perceptual matching of two rectangles, patients underestimated the left-sided stimulus. In a visuomotor task requiring the reproduction of the horizontal extent of a segment, patients exhibited a hyperextension, when a leftward movement was required. Conclusions: We showed a disordered representation of extrapersonal space, possibly involving a contralesional relaxation of the spatial medium. The deficit does not arise at the level of retinotopic coordinate frames and is independent of unilateral spatial neglect.