Abstract
In stroke patients, the clinical presentation of visual field defects (VFDs) is frequently accompanied by visual neglect, i.e., the inability to attend and respond to the contralesional space. However, the diagnostic discrimination between the lack of reactions to contralesional stimuli due to VFDs or visual neglect is challenging during clinical examination. This discrimination is particularly relevant, since both clinical pictures are associated with different therapeutic approaches and outcomes. The aim of this study was to systematically investigate the effectiveness of trunk rotation toward the contralesional side—a manipulation dissociating the coordinate system of the trunk from that of the head and eyes—in disentangling real VFDs from “pseudo-VFDs” that occur due to visual neglect. Twenty patients with a left-sided VFD after a right-hemispheric stroke (10 additionally showing visual neglect in neuropsychological testing, VFD + neglect; 10 without neglect, VFD) were tested with Goldmann perimetry in both standard and trunk rotation conditions. In the standard condition, both VFD and VFD + neglect patients showed a conspicuous narrowing of the left visual field. However, trunk rotation triggered strikingly different patterns of change in the two groups: it elicited a significant increase in visual field extension in the VFD + neglect group, but left visual field extension virtually unchanged in the VFD group. Our results highlight contralesional trunk rotation as a simple, viable manipulation to effectively and rapidly disentangle real VFDs from “pseudo-VFDs” (i.e., due to visual neglect) during clinical examination.
Highlights
Visual field defects (VFDs) are common in stroke patients
In patients with visual field defects (VFDs) + neglect, the mean left visual field extension was of 22°, whereas in patients with VFD, this extension was of 42°
The results of the perimetry in the trunk rotation condition showed that the left visual field extension significantly increased in patients with VFD + neglect, but remained unchanged in patients with VFD
Summary
Visual field defects (VFDs) are common in stroke patients. The diagnosis of VFDs is important, since patients with VFDs are significantly less independent than patients with an intact visual field, and they are significantly impaired in the activities of daily living [2, 3]. Stroke patients have VFDs and present with combined visual neglect. Similar to VFDs, neglect is common, occurring in up to 43% of patients in the acute phase after a right-hemispheric stroke and receding to 17% after 3 months [5]. Patients suffering from VFDs with additional visual neglect are known to be more impaired than patients suffering from VFDs alone (i.e., without visual neglect) [8,9,10]
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