Some debate remains as to whether underestimation of the horizontal size of objects in the left part of visual space is a general disturbance in spatial neglect. The issue is unclear because size perception may be influenced by factors other than neglect, e.g. visual field defects such as hemianopia. To disentangle these effects, we compared the performance of patients with pure neglect, pure hemianopia or both on the same size-comparison test. Whereas pure neglect was accompanied by misperception of horizontal object size, patients with pure hemianopia showed an even greater impairment of size perception. Accordingly, the area of maximum lesion overlap of these patients with impaired size perception was not centred around the parietotemporal cortex, which is typically associated with spatial neglect, but rather was found in the occipital lobe (Brodmann areas 17 and 18). The results suggest that spatial neglect is not an inevitable consequence of distorted size perception. The perceptual distortion of objects in the leftward parts of visual space is not sufficient to account for the occurrence of visuospatial neglect.