Federico Fellini
Federico Fellini is an internationally renowned film director and a distinguished painter and cartoonist. Cantagallo & Sala (1998) presented a case study of the neglect syndrome that appeared after Fellini experienced a right parietal stroke, specifically in the area of the middle cerebral artery of the right hemisphere. Fellini was first seen fifteen days after his stroke. His main symptoms included a severe motor and sensory deficit on the left side of his body, limited left-field vision, and unilateral visuo-spatial neglect. One interesting finding was that Fellini was aware of and extremely concerned about his motor difficulties. Thus, he showed a lack of anosognosia, which is usually associated with neglect. Fellini was oriented in time and space, and did not show any language or general cognitive difficulties. He also did not have prosopagnosia, which is the inability to recognize faces or people. Fellini had no short- or long-term memory deficits.
When Cantagallo & Sala (1998) investigated Fellini’s unilateral spatial neglect, they found that he presented with a clear left-sided visual extinction. Thus, Fellini was unable to orient himself to visual stimuli that were presented in the left side of space. On line cancellation tests, Fellini attended to and crossed out the majority of lines on the right side, while only crossing out a few on the left side. When attempting to copy geometric shapes, Fellini left out several details of the left part of single items. Fellini’s performance on copying the Rey figure showed apparent neglect and also poor memory performance.
Rey Figure – You can see that Fellini added embellishments, which show that he is aware of the left side, yet he still has trouble copying the left side of the figure. Cantagallo & Sala (1998).
On line bi-section tasks, Fellini consistently marked the mid point towards the right, a finding that is often seen in left neglect patients.
Line Bi-section Tasks – You can see that Fellini’s embellishments are mostly on the right side, but also a few on the left side, showing that he is aware of the left side of the line. Cantagallo & Sala (1998).
During the first assessment, Fellini showed neglect dyslexia, which is characterized by the initial or terminal part of the word being misread. Fellini’s neglect dyslexia included omissions, missing the first part of the word, and substitutions, putting different letters at the beginning of the word in place of the original letters. This neglect dyslexia had improved significantly by one month following Fellini’s stroke. Evidence was found that Fellini was able to implicitly process objects on the left side, even if he didn’t attend to them. Tests also showed that Fellini experienced no personal neglect.
Also, Fellini showed no obvious evidence of representational neglect in tasks involving long-term memory. Approximately one month after his stroke, Fellini could draw many items upon request. However, details on the left side of these drawings were often lacking.
Drawings from Memory – These are Fellini’s drawings of objects from memory. Details on the left side were still lacking. Cantagallo & Sala (1998).
Spontaneous Drawings - Fellini could also produce spontaneous drawings, which often showed little or no signs of neglect. Cantagallo & Sala (1998).
About two months after his stroke, all of Fellini’s drawing abilities had returned and his drawings, both upon request and spontaneous, showed no sign of neglect.
Recovery of Drawing Abilities – These pictures show Fellini’s recovery of his drawing abilities. These pictures show detail on both the right and left side of space.
Thus, Fellini’s drawings no longer showed signs of neglect. Cantagallo & Sala (1998).
Using a tactile searching task, Fellini’s neglect became apparent, particularly in the lower quadrant. When searching for items or targets, Fellini took significantly longer to find targets on the left side.
Perhaps the most interesting aspect of Fellini’s neglect is his awareness of his deficits. Cantagallo & Sala (1998) noted “anosognosia, unawareness or denial of impairment, of visuo-spatial disorders and (less frequently) of the sensory and motor deficits is often mentioned as a cardinal feature of the neglect syndrome” (p. 181). Also, a patient’s increased awareness of impairments usually signals or coincides with an improvement in the impairments. This is not the case with Fellini. From the first assessment, Fellini was fully aware of and very concerned by his impairments. This awareness did not lead to improvements in the impairments. Thus, Fellini is a good example that neglect is possible even when the patient is aware of their impairments.
The case study of Fellini is just one example of the many dissociations that occur with neglect syndrome. Many of Fellini’s symptoms were classic characteristics of neglect. However, other aspects, like his lack of anosognosia, were very unusual. As past research has shown, unusual symptoms are often the norm in most neglect cases.