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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(10): 1077-1078
DOI: 10.1055/s-0042-1758394
Images in Neurology

Eastchester clapping sign and networks related to spatial attention

Sinal de palmas de Eastchester e redes relacionadas à atenção espacial
Gustavo José Luvizutto 
1   Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil.
,
Gabriel Pereira Braga 
2   Universidade Federal do Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian, Campo Grande MS, Brazil.
,
Luiz Eduardo Gomes Garcia Betting 
3   Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil.
,
Rodrigo Bazan 
3   Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil.
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A 53-year-old right-handed man developed left hemiparesis (of grade 2 in the Medical Research Council Scale) and right head deviation due to ischemic stroke. When instructed to clap his hands, he brought his right hand to the midline and searched for the other hand ([Video 1]). Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) scans, the unilateral spatial neglect (USN) test, and the blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) study are presented in [Figure 1].

Video 1 Eastchester clapping sign (ECS-1 = searching in the contralateral hemispace for the other hand). In the video, the neurologist dictates the following command to the patient: “Please clap your hands.”

Link: https://www.arquivosdeneuropsiquiatria.org/wp-content/uploads/2022/04/ANP-2022.0020-video.mov


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Figure 1 (A) FLAIR MRI scan showing extensive ischemic stroke in the right hemisphere; (B) line cancellation test (Albert test) indicating presence of unilateral spatial neglect; (C) BOLD fMRI study at rest showing no activation; (D) BOLD fMRI study showing bilateral activation of the parietal cortex during sensory stimulation (face-hand test).

The Eastchester clapping sign provides evidence of USN phenomena.[1] [2] Frequently, patients with USN can ignore problems with the affected limb. This patient presented bilateral activation in the networks related to spatial attention (mainly parietal posterior lobes), and fMRI patterns indicated maladaptive plasticity.[3] [4]


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Conflict of Interest

The authors have no conflict of interests to declare.

Authors' Contributions

GJL, GPB, LEGGB, RB: substantial contributions to the conception or design of the work, acquisition, analysis, and interpretation of data, drafting and critical revision of the manuscript for important intellectual content, and final approval of the version to be published.


  • References

  • 1 Ostrow LW, Llinás RH. Eastchester clapping sign: a novel test of parietal neglect. Ann Neurol 2009; 66 (01) 114-117
    CrossrefPubMedGoogle Scholar
  • 2 Mukerji SS, Bevers MB, Prasad S. Eastchester clapping sign. Neurol Clin Pract 2014; 4 (02) 178-179
    CrossrefPubMedGoogle Scholar
  • 3 Corbetta M, Shulman GL. Spatial neglect and attention networks. Annu Rev Neurosci 2011; 34: 569-599
    CrossrefPubMedGoogle Scholar
  • 4 Rema V, Ebner FF. Lesions of mature barrel field cortex interfere with sensory processing and plasticity in connected areas of the contralateral hemisphere. J Neurosci 2003; 23 (32) 10378-10387
    CrossrefPubMedGoogle Scholar

Address for correspondence

Gustavo José Luvizutto

Publication History

Received: 26 January 2022

Accepted: 29 March 2022

Article published online:
19 December 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Ostrow LW, Llinás RH. Eastchester clapping sign: a novel test of parietal neglect. Ann Neurol 2009; 66 (01) 114-117
    CrossrefPubMedGoogle Scholar
  • 2 Mukerji SS, Bevers MB, Prasad S. Eastchester clapping sign. Neurol Clin Pract 2014; 4 (02) 178-179
    CrossrefPubMedGoogle Scholar
  • 3 Corbetta M, Shulman GL. Spatial neglect and attention networks. Annu Rev Neurosci 2011; 34: 569-599
    CrossrefPubMedGoogle Scholar
  • 4 Rema V, Ebner FF. Lesions of mature barrel field cortex interfere with sensory processing and plasticity in connected areas of the contralateral hemisphere. J Neurosci 2003; 23 (32) 10378-10387
    CrossrefPubMedGoogle Scholar

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Zoom Image
Figure 1 (A) FLAIR MRI scan showing extensive ischemic stroke in the right hemisphere; (B) line cancellation test (Albert test) indicating presence of unilateral spatial neglect; (C) BOLD fMRI study at rest showing no activation; (D) BOLD fMRI study showing bilateral activation of the parietal cortex during sensory stimulation (face-hand test).