Based on the similarity of brain areas lesioned in neglect and those activated by spatial working memory (WM) tasks in normals, we hypothesized that neglect may involve spatial WM impairments. A left neglect patient with right inferior frontal and basal ganglia damage performed cancellation tasks, making either highly visible marks (to provide a reminder of visited items), or invisible marks (so only spatial WM could represent cancelled items). Invisible marks led to repeated cancellations for targets that differed only in location, but not for targets with memorable unique identities, suggesting a deficit of spatial WM, with non-spatial WM spared. Neglect was greater for cancellation with invisible marks, consistent with a role for deficient spatial WM in cancellation deficits, but contrary to account solely in terms of attention capture by salient visible marks made in ipsilesional space.