The severity of unilateral spatial neglect was positively correlated with that of Pusher syndrome

Abstract

While previous studies have reported that unilateral spatial neglect (USN) and pusher syndrome are related but independent symptoms, their relationship has not been investigated using a quantitative scale and causative lesions using brain imaging. This study aimed to clarify the relationship between evaluation scores and the extent of the damaged area revealed by brain imaging. We evaluated twenty patients with first-ever stroke and pusher syndrome (14 right and 6 left hemispheric patients). First, we analyzed the relationship between the Catherine Bergego Scale (CBS) and Scale for Contraversive Pushing (SCP). We also introduced a new way of quantifying the affected brain lesions at two levels of horizontal brain imaging slice. At each level, a brain hemisphere was divided into 3 areas, and the total number of damaged areas from these two levels was used as an indication of the extent of the damaged lesion, ranging 0 to 6 ( Fig. 1 ). By using this score, the relationship between the CBS and SCP scores was further examined. All patients with pusher syndrome had USN based on CBS. In each subject, the CBS score was positively correlated with the SCP score (Spearman = 0.805, P < 0.001) ( Fig. 2 ). Brain imagining showed that six patients had damage in both slice 1 and slice 2, while the fourteen patients had damage only in slice 2. The imaging score at slice 1 was correlated with the CBS score in the first group. The severity of USN was positively correlated with that of pusher syndrome with clinical scales. The location and extent of the damaged area in relation to SCP and CBS needs to be examined with a larger sample size in future.