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is separable from visual agnosia (see De Renzi et al); curiously, it may be worsened by the introduction of visual cues Subtle differences between the allocation of spatial attention to sound (auditory neglect) and a distortion in its localization may be found in different cases, but the main lesion usually lies in the right superior lobule, and the same bias for left hemispheric lesions applies as for visual inattention In summary, the effects of disease of the parietal lobes are as follows: I Effects of unilateral disease of the parietal lobe, right or left A Corticosensory syndrome and sensory extinction (or total hemianesthesia with large acute lesions of white matter) B Mild hemiparesis (variable), unilateral muscular atrophy in children, hypotonia, poverty of movement, hemiataxia (all seen only occasionally) C Homonymous hemianopia or inferior quadrantanopia (incongruent or congruent) or visual inattention D Abolition of optokinetic nystagmus with target moving toward side of the lesion E Neglect of the opposite side of external space (far more prominent with lesions of the right parietal lobe see below) II Effects of unilateral disease of the dominant (left) parietal lobe (in right-handed and most left-handed patients) additional phenomena include A Disorders of language (especially alexia) B Gerstmann syndrome (dysgraphia, dyscalculia, nger agnosia, right-left confusion) C Tactile agnosia (bimanual astereognosis) D Bilateral ideomotor and ideational apraxia (see Chap 3) III Effects of unilateral disease of the nondominant (right) parietal lobe A Visuospatial disorders B Topographic memory loss C Anosognosia, dressing and constructional apraxias (these disorders may occur with lesions of either hemisphere but one observed more frequently and are of greater severity with lesions of the nondominant one) D Confusion E Tendency to keep the eyes closed, resist lid opening, and blepharospasm IV Effects of bilateral disease of the parietal lobes A Visual spatial imperception, spatial disorientation, and complete or partial Balint syndrome (optic apraxia, described below) With all these parietal syndromes, if the disease is suf ciently extensive, there may be a reduction in the capacity to think clearly as well as inattentiveness and slightly impaired memory It is still not possible to present an all-embracing formula of parietal lobe function It does seem reasonably certain that, in addition to the perception of somatosensory impulses (postcentral gyrus), the parietal lobe participates in the integration of all sensory data, especially those that provide an awareness of one s body as well as a percept of one s surroundings and of the relation of one s body to extrapersonal space and of objects in the environment to each other In this respect, the parietal lobe may be regarded as a.

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special high-order sensory organ the locus of transmodal (intersensory) integrations, particularly tactile and visual ones, which are the basis of our concepts of spatial relations In this way, parietal lesions cause disorders of speci c types of self-consciousness or self-awareness that are tied to sensory modalities, but they do not do so in the fundamental way that results from lesions of the temporal lobe Useful references on parietal function include Critchley s monograph on the parietal lobes and the chapter by Botez et al in the Handbook of Clinical Neurology

temporal visual zones lose the ability to identify objects; with posterior parietal lesions, there is loss of ability to locate objects And, as Hubel and Wiesel have shown, the response patterns of neurons in both occipital lobes to edges and moving visual stimuli, to onand-off effects of light, and to colors are much different from what was originally supposed Hence, form, location, color, and movement each have separate localizable mechanisms The monographs of Polyak and of Miller contain detailed information about the anatomy and physiology of this part of the brain

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