Abstract
The crossed leg sign in patients with right hemisphere stroke is thought to be associated with perceptual disorders, such as unilateral spatial neglect (USN). The aim of this study was to compare the crossed leg sign with the severity of USN during the acute phase of stroke. This was an observational and prospective clinical study of individuals with a diagnosis of right parietal stroke, as confirmed by neuroimaging. The occurrence of the crossed leg sign, the time at which this occurred after the stroke, and a clinical diagnosis of USN were measured and recorded. The patients' age, sex, and lesion severity, as determined by the National Institutes of Health Stroke Scale and Glasgow coma scale, were included in the analyses as confounding variables. The outcome of interest was the degree of USN, as measured by the cancellation and bisection tests. Binary logistic regression was used to analyze the effect of crossed leg syndrome on the severity of USN. In the adjusted multiple regression model, a p-value of <0.05 was considered statistically significant. Overall, 60 patients were included in this study. There were no associations between patient demographics and the presence of the crossed leg sign. There was, however, an association between the crossed leg sign and the absolute value of the deviation in the line bisection test (B = -0.234; p = 0.039). The crossed leg sign was not associated with other measures of USN. Based on the results of our study, we can conclude that a crossed leg sign in the acute phase of stroke is associated with USN severity, specifically the misinterpretation of the midline.
Highlights
Unilateral spatial neglect (USN) is a perceptual disorder that is characterized by an inability to respond to people or objects that are presented contralateral to the lesioned side of the brain when these symptoms cannot be attributed to either motor or sensory deficits [1,2,3]
The crossed leg sign was first described in patients with right hemisphere stroke who presented with USN, including cases in which there were associated changes in consciousness [7]
Patients hospitalized in the Emergency Room at the Stroke Unit at the Botucatu Medical School in Botucatu, Brazil were included in this study and were followed from January to December 2016
Summary
Unilateral spatial neglect (USN) is a perceptual disorder that is characterized by an inability to respond to people or objects that are presented contralateral to the lesioned side of the brain when these symptoms cannot be attributed to either motor or sensory deficits [1,2,3]. It is impossible to detect USN during coma, but frequent rubbing movements of the right leg over the left observed in the first days of clinical evolution may differentiate between patients with torpor and coma. This sign is characterized by an overlap of the right leg over the left as the patient attempts to orient to the midline because there is a loss of spatial orientation of the left space. The crossed leg sign in patients with right hemisphere stroke is thought to be associated with perceptual disorders, such as unilateral spatial neglect (USN). In the adjusted multiple regression model, a p-value of
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