'Unilateral inattention' is a common effect of stroke, writes THOMAS LYNCH.
Q My husband had a stroke three months ago which has left him with poor movement in the left side of his body.
This is not the end of the story though. In the mornings, when he is dressing, he forgets to put the left side of his clothes on; he only shaves the right hand side of his face; only finishes half of his meals; and I have lost count of the number of times he has collided with doors when leaving and entering rooms.
Our GP says it is just part of his stroke, and these things might improve in time but we are very worried about what might be happening.
A It sounds like your husband’s stroke may have affected a part of his brain on the right-hand side that is involved in perceiving and registering visual information coming in from the left; or to put it another way, information in his left “visual field” is not being attended to by the brain.
Essentially, it is like the left- hand side of his body, or the left-hand side of the meal on his plate, is not available to him, or not there for him, until his attention is drawn to it.
As strange as this symptom may sound, this “unilateral inattention” is a fairly common result of damage to a region of the brain called the right Parietal lobe. The Parietal lobes (one on the left side and one on the right side) are situated behind the ears towards the back of the head.
They are important for bringing together information from the different senses and also for making sense of the information coming to the brain from the body.
So, you might ask, why is it that damage on the right side of the brain can lead to problems on the left side of the body or the left visual field? In general, the right side of the brain (right hemisphere) is responsible for perceiving information and controlling movement on the left, while the left hemisphere is responsible for this work on the right.
As you husband’s difficulties seem to be with perceiving visual information, you may be able to help him to compensate for this part of his difficulty by a very simple strategy.
As silly as it sounds, simply get your husband to “imagine himself being like a horizon-illuminating lighthouse”, when he is undertaking tasks or moving around so that he begins to learn to scan and give his attention to the breadth of his environment again. This should begin to help him to compensate for this part of his disability.
Q I am 39 years old and recently noticed blood in my semen. It was rather alarming but do I need to worry about it?
A Blood in the semen, also known as hematospermia, can be a very alarming symptom, however, bloody semen is almost never a sign of a serious underlying medical problem. In most cases, bleeding presumably follows damage to small blood vessels in the urinary tract or prostate gland.
This may come from minor trauma or irritation, or growth of normal blood vessels. Small amounts of blood may linger in the semen for weeks, but almost all cases resolve on their own.
It’s very rare for bleeding to come from a serious cause such as cancer and this is particularly true for men under 40. Young men who have a single episode of bleeding that goes away on its own generally need no evaluation other than an examination by your doctor and a urine specimen.
A more thorough work-up may be worthwhile in older men, or in men who have persistent or recurring episodes of bleeding. Such a work-up might include cystoscopy, which is an inspection of the bladder, an ultrasound of the bladder and prostate.
However, most of these evaluations will be entirely normal. In fact, even after extensive testing, it’s unusual for a specific cause of the bleeding to be identified.
Possible rarer causes of blood in the semen include the following: urinary tract infections; prostatitis (inflammation of the prostate); sexually transmitted diseases such as gonorrhoea or chlamydia; benign prostate hyperplasia (benign non- cancerous enlargement of the prostate); surgical procedures such as prostate biopsy or bladder catheterisation; trauma to the testicles or prostate; cancer of the prostate, bladder or reproductive organs.
- This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Dónal Fortune, senior clinical neuropsychologist with the Peter Bradley Foundation, Acquired Brain Injury Services Ireland