Abstract
Background and purposeThere is growing evidence that visuospatial neglect (VSN) is associated with lower functional performance in other modalities and is not restricted to the lesioned hemisphere alone, and may also affect the non-lesioned hemisphere in severe first-ever strokes. We aimed to investigate the longitudinal association between the severity of VSN, as reflected by the extent of ipsilesional and contralesional spatial attention deficit, and clinical severity of stroke.MethodsThis is a secondary data analysis with merged data from two prospective cohort studies. Resulting in 90 patients and 8 longitudinal measurements at 1, 2, 3, 4, 5, 8, 12, and 26 weeks post-stroke onset. A letter cancellation test (LCT) was used as the primary outcome measure to demonstrate presence and severity of VSN. The clinical severity of stroke was classified using the Bamford Classification.ResultsNo significant association between clinical severity and the number of ipsilesional, as well as contralesional, omissions on the LCT was observed. Recovery of VSN at the contralesional hemiplegic, as well as ipsilesional non-hemiplegic side, was only dependent on ‘time’ as a reflection of spontaneous neurobiological recovery post-stroke. The recovery of the ipsilesional extension of VSN was significantly slower for the total anterior circulation infarct (TACI) group compared to the non-TACI group.ConclusionsLarger strokes have a significant negative impact on recovery of visual attention at the non-hemiplegic side. No clinical determinants that regulate spontaneous time-dependent recovery of VSN were found. While early ‘stroke severity’ has been regarded as a strong predictor of functional outcome at a group level, other prognostic factors (demographic, stroke related) need to be determined.Clinical trial registrationEXPLICIT-stroke Trial: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1424Stroke Intensity Trial: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1665
Highlights
Visuospatial neglect (VSN) is a frequent disorder following stroke, leaving patients with impaired or even lost awareness for contralesional stimuli and/or events
The recovery of the ipsilesional extension of VSN was significantly slower for the total anterior circulation infarct (TACI) group compared to the non-TACI group
Barthel index (BI): Barthel Index; FMA-arm: Fugl-Meyer Assessment arm; letter cancellation test (LCT): Letter Cancellation Test; MI: Motricity Index; TACI: total anterior circulation infarct according to the Bamford classification; non-TACI: other classification than TACI, according to the Bamford classification [12]
Summary
Visuospatial neglect (VSN) is a frequent disorder following stroke, leaving patients with impaired or even lost awareness for contralesional stimuli and/or events (i.e. side of space opposite to the lesioned hemisphere). In very severe cases of VSN, the deficit may encompass stimuli and/or events at the ipsilesional side, in other words, the same side of space as the lesioned hemisphere. There is growing evidence that VSN is associated with lower functional performance in other neurological modalities [9] and not restricted to the lesioned hemisphere alone. There is growing evidence that visuospatial neglect (VSN) is associated with lower functional performance in other modalities and is not restricted to the lesioned hemisphere alone, and may affect the non-lesioned hemisphere in severe first-ever strokes. We aimed to investigate the longitudinal association between the severity of VSN, as reflected by the extent of ipsilesional and contralesional spatial attention deficit, and clinical severity of stroke.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
