Reversed clock phenomenon: A right-hemisphere syndrome
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Sensory stimuli are commonly mislocalized to the corresponding site on the opposite side of the body or space.1-3 Patients with visual neglect often transpose the locations of objects in scenes that they describe from memory.4 The clock-drawing task is useful in assessing impairments of spatial executive function and in discriminating them from nonexecutive constructional failure.5,6 We identified 6 of 380 consecutive patients (1.6%) with stroke in the right hemisphere who showed spontaneously reversed placement of the numbers of a clock without number omissions. Three of these six patients also showed mental imagery reversal in their descriptions of remembered scenes of their environment.
The clock-drawing task was performed by giving instructions to the patients to place the numbers of a clock on a previously drawn circle. Reversed number sequencing on clock drawing was resolved in 2 weeks in all patients. None of the patients with left-hemisphere stroke (n = 320) showed reversed clock drawing. Radiologic examinations revealed infarcts in three patients and hemorrhage in the other three patients in either the cortical or subcortical areas (figure).
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