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Reversed clock phenomenon: A right-hemisphere syndrome

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). 



Figure. Redrawn templates show clock drawings and the site of …