An adult client exhibits visuospatial disorganization, an inability to initiate interactions, left-side neglect, and lack of facial expression. This combination is most likely associated with which of the following?

• A. Right-hemisphere traumatic brain injury
• B. Left-hemisphere cerebrovascular accident
• C. Bilateral traumatic brain injury
• D. Alzheimer's dementia

Answer: (A)

Damage to the right hemisphere disrupts attention to space and the ability to engage with others, leading to a characteristic pattern seen here. Left-side neglect occurs when the right parietal lobe (which directs attention to the left side of space) is damaged, so the person may ignore stimuli on the left. Inability to initiate interactions and a flat facial expression point to involvement of right frontal networks that regulate motivation and affect. This combination—visuospatial disorganization, left neglect, and reduced initiation with diminished facial expressiveness—is classic for a right-hemisphere traumatic brain injury.

Left-hemisphere damage would more typically produce language problems and may spare left-side neglect. Alzheimer’s dementia usually presents with progressive memory impairment and later visuospatial issues rather than a distinct pattern of left-sided neglect and flat affect from a unilateral lesion. Bilateral injury could produce broad deficits, but the unilateral left neglect specifically points to right-hemisphere involvement, making that option the best fit.