Vision and Visuomotor Performance Following Acute Ischemic Stroke.

Chamini Wijesundera,Tissa Wijeratne,Algis J Vingrys,Sheila G Crewther

doi:10.3389/fneur.2022.757431

Abstract

BackgroundAs measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.MethodsSixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission.ResultsOf the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, p < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, p < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R (n = 26, 84.3 ± 55.3 s) and L (n = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: −0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores.ConclusionsEHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke.

Highlights

Stroke is defined as sudden onset focal disturbance of cerebral function, lasting more than 24 hours, or leading to death, and with no apparent cause other than that of vascular origin [1]
Ethics approval was provided by Sunshine Hospital (Western Health Ethics Committee HREC/16/WH/1) review board and the study was conducted in accordance with the tenets of the Declaration of Helsinki with all participants giving informed consent to participate
As visual acuity-in-noise is a foveal task, we considered whether foveal thresholds might influence hemianopia

Summary

Introduction

Stroke is defined as sudden onset focal (or global) disturbance of cerebral function, lasting more than 24 hours, or leading to death, and with no apparent cause other than that of vascular origin [1]. Upper limb function is often impaired acutely [8–10] leading to reduced manual and coordination of visually guided motor tasks contralateral to the site of the brain lesion [3, 11]. We have recently reported that ∼2/3 of mild-moderate severity first episode acute ischemic stroke (AIS) patients with no previous history of impaired vision, experience deteriorated visual acuity-in-noise (VAn) with contralateral visual field defects immediately (i.e., within 7 days) after stroke [17]. Given the ubiquity of motor involvement in stroke, we set out to examine and quantify visuomotor performance in the same group of hospitalized AIS cases whose sensory visual capacity was reported in the past [17], and for this study, we added a motor eye-hand coordination task. As measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients

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