Recovery from visuospatial neglect in stroke patients

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 64; no. 4; pp. 555 - 557
• Main Authors: Cassidy, Timothy P, Lewis, Susan, Gray, Christopher S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-04-1998; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cerebrovascular Disorders - physiopathology; Coma; Convalescence; Female; Functional Laterality; Geriatrics; Humans; lateralised and non-lateralised deficits; Male; Medical sciences; Middle Aged; Mortality; Neurology; Neuropsychological Tests; Predictive Value of Tests; Prognosis; Prospective Studies; Rehabilitation; Short Report; Space Perception; Statistics, Nonparametric; Stroke; Studies; Vascular diseases and vascular malformations of the nervous system; Visual Perception; visuospatial neglect; United Kingdom > UK; Scotland; Edinburgh Scotland; Human; Nervous system diseases; Stroke; Prognosis; Error estimation; Right; Cardiovascular disease; Psychometrics; Cerebral disorder; Vascular disease; Cerebral hemisphere; Central nervous system disease; Predictive value; Adult; Complication; Evolution; Cerebrovascular disease
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.64.4.555

OBJECTIVES To describe the natural recovery of visuospatial neglect in stroke patients and the distribution of errors made on cancellation tests using a standardised neuropsychological test battery. METHOD A prospective study of acute (< seven days) patients with right hemispheric stroke. Patients identified with visuospatial neglect were followed up for three months with monthly clinical and neuropsychological testing RESULTS There were 66 patients with acute right hemispheric stroke assessed of whom 27 (40.9%) had evidence of visuospatial neglect. Patients with neglect, on admission, had a mean behavioural inattention test (BIT) score of 56.3, range 10–126 (normal>129). Three of the subtests identified errors being made in both the right and left hemispaces. During follow up, recovery occurred across both hemispaces, maximal in the right hemispace. Recovery from visuospatial neglect was associated with improvement in function as assessed by the Barthel score. At the end of the study period only six (31.5%) patients had persisting evidence of neglect. On admission the best predictor of recovery of visuospatial neglect was the line cancellation test (Spearman’s rank correlationr=−0.4217, p=0.028). CONCLUSION The demonstration of errors in both hemispaces has implications for the theory that neglect is a lateralised attentional problem and is important to recognise in planning the rehabilitation of stroke patients.