Non-dominant Hemispheric Stroke Research Articles

The association between serum S100β levels and prognosis in acute stroke patients after intravenous thrombolysis: a multicenter prospective cohort study

BackgroundS100β is a biomarker of astroglial damage, the level of which is significantly increased following brain injury. However, the characteristics of S100β and its association with prognosis in patients with acute ischemic stroke following intravenous thrombolysis (IVT) remain unclear.MethodsPatients in this multicenter prospective cohort study were prospectively and consecutively recruited from 16 centers. Serum S100β levels were measured 24 h after IVT. National Institutes of Health Stroke Scale (NIHSS) and hemorrhagic transformation (HT) were measured simultaneously. NIHSS at 7 days after stroke, final infarct volume, and modified Rankin Scale (mRS) scores at 90 days were also collected. An mRS score ≥ 2 at 90 days was defined as an unfavorable outcome.ResultsA total of 1072 patients were included in the analysis. The highest S100β levels (> 0.20 ng/mL) correlated independently with HT and higher NIHSS at 24 h, higher NIHSS at 7 days, larger final infarct volume, and unfavorable outcome at 3 months. The patients were divided into two groups based on dominant and non-dominant stroke hemispheres. The highest S100β level was similarly associated with the infarct volume in patients with stroke in either hemisphere (dominant: β 36.853, 95% confidence interval (CI) 22.659–51.048, P < 0.001; non-dominant: β 23.645, 95% CI 10.774–36.516, P = 0.007). However, serum S100β levels at 24 h were more strongly associated with NIHSS scores at 24 h and 3-month unfavorable outcome in patients with dominant hemisphere stroke (NIHSS: β 3.470, 95% CI 2.392–4.548, P < 0.001; 3-month outcome: odds ratio (OR) 5.436, 95% CI 2.936–10.064, P < 0.001) than in those with non-dominant hemisphere stroke (NIHSS: β 0.326, 95% CI − 0.735–1.387, P = 0.547; 3-month outcome: OR 0.882, 95% CI 0.538–1.445, P = 0.619). The association of S100β levels and HT was not significant in either stroke lateralization group.ConclusionsSerum S100β levels 24 h after IVT were independently associated with HT, infarct volume, and prognosis in patients with IVT, which suggests the application value of serum S100β in judging the degree of disease and predicting prognosis.

Hebbian plasticity induced by temporally coincident BCI enhances post-stroke motor recovery

Functional electrical stimulation (FES) can support functional restoration of a paretic limb post-stroke. Hebbian plasticity depends on temporally coinciding pre- and post-synaptic activity. A tight temporal relationship between motor cortical (MC) activity associated with attempted movement and FES-generated visuo-proprioceptive feedback is hypothesized to enhance motor recovery. Using a brain–computer interface (BCI) to classify MC spectral power in electroencephalographic (EEG) signals to trigger FES-delivery with detection of movement attempts improved motor outcomes in chronic stroke patients. We hypothesized that heightened neural plasticity earlier post-stroke would further enhance corticomuscular functional connectivity and motor recovery. We compared subcortical non-dominant hemisphere stroke patients in BCI-FES and Random-FES (FES temporally independent of MC movement attempt detection) groups. The primary outcome measure was the Fugl-Meyer Assessment, Upper Extremity (FMA-UE). We recorded high-density EEG and transcranial magnetic stimulation-induced motor evoked potentials before and after treatment. The BCI group showed greater: FMA-UE improvement; motor evoked potential amplitude; beta oscillatory power and long-range temporal correlation reduction over contralateral MC; and corticomuscular coherence with contralateral MC. These changes are consistent with enhanced post-stroke motor improvement when movement is synchronized with MC activity reflecting attempted movement.

Non-dominant hemisphere stroke and spatial neglect: is stimulation of known hobbies and cravings a way to make rehabilitation more effective?

Stroke is an acute neurologic injury that occurs because of brain ischemia or brain hemorrhage. Improved treatment options for stroke have increased patient survival, but the condition remains the leading cause of long-term disability worldwide. The huge costs and adverse impact of post-stroke disability make improving rehabilitation strategies a priority. Spatial neglect (SN) is characterized as a condition in which patients display insufficient attention to the contralesional side of their surroundings and their own body. It is the most common neurocognitive disorder causing long-term disability, occurring in approximately half of patients with stroke in the non-dominant brain hemisphere. Typical adjacent consequences of SN are difficulties with attention, perception, learning, memory, recognition, motivation, and expression of emotions. Numerous rehabilitation techniques have been designed to alleviate and remediate symptoms of SN. Paradoxically, many of these techniques have not found their way into routine clinical bedside rehabilitation. Rehabilitators may be reluctant to implement unfamiliar strategies, especially if they are new, controversial, or not tested in a clinical environment. In this paper, we propose a hypothesis that better rehabilitation results for stroke survivors with SN can be reached by including patients’ hobbies and cravings when training attention towards the neglected space during rehabilitation. Patients’ unique cravings and hobbies when used as conditioned cueing may help boost the mesolimbic dopamine system and eliminate hemispheric imbalance, which is thought by many to cause SN.

Is segmental muscle strength recovery different in patients with dominant versus non-dominant hemispheric ischemic stroke?

Abstract Introduction &amp; objectives: Starting from the well-known functional hemispheric asymmetry and concomitantly, from the clinical findings of practitioners involved in the post-stroke rehabilitation process, the aim of this study was to evaluate whether ischemic stroke in the dominant hemisphere results in more severe initial motor deficit and if its motor recovery is decreased compared to that of the non-dominant hemisphere. Material and method: This was a retrospective study, comprising 39 patients with ischemic stroke in the middle cerebral artery territory, divided into two groups depending on the hemispheric location of the lesion (left/right). They were evaluated for their segmental muscle strength using the Medical Research Council Muscle Strength Grading Scale, both in terms of initial value and evolution between two successive admissions. Results and conclusions: No significant difference was found for motor deficit evaluated on the occasion of the first admission between patients with left-side stroke and those with right-side stroke. Motor recovery was more obvious proximally in the paretic limbs, but without statistical significance. Key words: hemispheric dominance, functional laterality, stroke, motor rehabilitation,

Underdiagnosis of Unilateral Spatial Neglect in stroke unit.

Unilateral spatial neglect (USN) is the incapacity to respond to stimuli presented opposite to a dysfunctional cerebral hemisphere. It is usually caused by non-dominant hemisphere lesions, leads to poorer prognosis and might be underdiagnosed. The objectives of the study were to ascertain the presence of USN in acute stroke patients and analyze the possible degree of underdiagnosis in a Stroke Unit. Prospective study of consecutive non-dominant hemisphere stroke patients within a period of 21months. "Line Bisection" and "Triangles Cancellation" tests were used for USN screening and "Circle Gap Detection Task" to confirm the USN. The results were compared with routine Stroke Unit assessment using the NIHSS to determine the possible degree of underdiagnosis. A total of 62 subjects, 38 women (61.29%), mean age of 74.05 (SD 10.5) years, were included. USN was diagnosed in 25 cases (40.3%) but 56% of them were not detected in routine evaluation using the NIHSS. Unilateral spatial neglect, a common cognitive deficit after acute stroke, is greatly underdiagnosed in routine Stroke Unit assessment. The use of simple USN-specific screening tools would improve diagnosis and therefore the possibility of implementing appropriate rehabilitation strategies.

Veidrodžio terapijos reikšmė motorinei bei sensorinei funkcijai, skausminiam sindromui bei asocijuotos galvos smegenų žievės reorganizacijai po persirgto insulto

Tyrimo tikslas – apžvelgti patikimais įrodymais pagrįstą literatūrą apie veidrodinės terapijos (VT) efektyvumą pacientams, persirgusiems galvos smegenų insultu. Tyrimo medžiaga ir metodai. Atliekant sisteminę apžvalgą, mokslinių straipsnių paieška vykdyta duomenų bazėse: PubMed, BioMedCentral, Tylor&amp;amp;amp;Francis, CohraneLibrary, ScienceDirect. Mokslinių straipsnių paieška atlikta pagal kiekvienai duomenų bazei pritaikytą specialią paieškos strategiją. Paieškai buvo panaudoti šie raktažodžiai: „mirror therapy“, „rehabilitation“, „stroke“, „upper limb“, „recovery of function“, „mirror movement“, „phantom limb pain „, „mirror visual feedback“, „mirror neurons system“. Į sisteminę apžvalgą įtraukti anglų kalba 2008–2016 metais publikuoti atsitiktinių imčių kontroliuojami arba kontroliuojami prieš ir po tyrimai, kuriuose buvo vertinama VT įtaka paralyžiuotos galūnės motorinei ir sensorinei funkcijai, skausmo intensyvumui bei asocijuotos galvos smegenų žievės reorganizacijai. Tyrimo rezultatai. Į sisteminę apžvalgą įtraukta 11 tyrimų. Tyrimuose buvo suformuotos dvi grupės: tiriamųjų, kuriems buvo taikyta standartinė bei VT, ir kontrolinė grupė, kuriai buvo taikoma tik standartinė terapija. Daugelyje tyrimų VT taikyta vieną mėnesį. Rezultatai buvo vertinami prieš taikytą terapiją ir po jos. Apžvelgus visus šiuos 11 straipsnių stebime, kad tose tiriamųjų grupėse, kuriose naudojama VT, ženkliai pagerėja pacientų paralyžiuotos galūnės motorinė funkcija, padidėja vikrumas, sumažėja skausmas. Išvados. VT didina smegenų aktyvumą ipsilateralinėje motorinėje žievėje, somatosensorinėje zonoje, skatina asocijuotos žievės reorganizaciją, taip pat ji padeda pasiekti geresnių rezultatų pacientams, patyrusiems nedominuojančio pusrutulio insultą, sumažina persirgus insultu atsiradusį skausmą bei padidina po insulto sumažėjusį galūnių vikrumą. VT yra veiksminga ne tik gydant ūmiu ir poūmiu insultu, tačiau ir lėtiniu galvos smegenų insultu sergančius pacientus.

Language performance and cognitive function in persons with nondominant-hemispheric stroke

This study investigated the relationship between language performance and cognitive function in stroke patients after nondominant hemisphere damage. The results of a battery of formal language tests, K-WAB, of seventy-eight patients were analyzed. The correlation between their K-WAB and K-MMSE scores was analyzed. Multivariate analysis of covariance adjusting for educational years in each of K-WAB and K-MMSE was conducted in accordance with the brain lesion location. Only 35.9 % of patients were classified as normal and the remaining 64.1 % were categorized as subnormal by K-WAB. There was a positive correlation between their language and cognitive functions. Outcomes differed according to lesion location, as the SAH group exhibited a significantly lower performance in both language and cognitive evaluations than the other groups. Cognitive-communicative disorders in stroke patients with nondominant-hemispheric lesions present in different ways. In-depth language evaluation of all brain-damaged patients should be conducted so that language defects of patients are not ignored.

The Effectiveness of 1 Hz rTMS Over the Primary Motor Area of the Unaffected Hemisphere to Improve Hand Function After Stroke Depends on Hemispheric Dominance.

Inhibition of motor cortex excitability of the contralesional hemisphere may improve dexterity of the affected hand after stroke. 40 patients (17 dominant hemispheric stroke, 23 non-dominant hemispheric stroke) with a mild to moderate upper limb motor impairment were enrolled in a double-blind, randomized, placebo-controlled trial with two parallel-groups. Both groups received 15 daily sessions of motor training preceded by either 1 Hz rTMS or sham rTMS. Behavioral and neurophysiological evaluations were performed at baseline, after the first week and after the third week of treatment, and after a 6 months follow-up. In both groups motor function of the affected hand improved significantly. Patients with stroke of the non-dominant hemisphere made a similar improvement, regardless of whether the motor training was preceded by sham or 1 Hz rTMS. Patients with stroke of the dominant hemisphere had a less favorable improvement than those with stroke of the non-dominant hemisphere after motor training preceded by sham rTMS. However, when 1 Hz rTMS preceded the motor training, patients with stroke of the dominant hemisphere made a similar improvement as those with stroke of the non-dominant hemisphere. Motor recovery of the affected upper limb after stroke is determined by dominance of the affected hemisphere. Stroke of the dominant hemisphere is associated with per se poorer improvement of the affected hand. 1 Hz rTMS over the contralesional M1 significantly improves dexterity of the affected hand in patients with stroke of the dominant hemisphere, but not in those with stroke of the non-dominant hemisphere.

Recovered vs. not-recovered from post-stroke aphasia: The contributions from the dominant and non-dominant hemispheres

Several adult studies have documented the importance of the peri-stroke areas to aphasia recovery. But, studies examining the differences in patterns of cortical participation in language comprehension in patients who have (LMCA-R) or have not recovered (LMCA-NR) from left middle cerebral artery infarction have not been performed up to date. In this study, we compare cortical correlates of language comprehension using fMRI and semantic decision/tone decision task in 9 LMCA-R and 18 LMCA-NR patients matched at the time of stroke for age and handedness. We examine the cortical correlates of language performance by correlating intra- and extra-scanner measures of linguistic performance with fMRI activation and stroke volumes. Our analyses show that LMCA-R at least 1 year after stroke show a return to typical fMRI language activation patterns and that there is a compensatory reorganization of language function in LMCA-NR patients with shifts to the right hemispheric brain regions. Further, with increasing strength of the left-hemispheric fMRI signal shift there are associated improvements in performance as tested with standardized linguistic measures. A negative correlation between the size of the stroke and performance on some of the linguistic tests is also observed. This right-hemispheric shift as a mechanism of post-stroke recovery in adults appears to be an ineffective mode of language function recovery with increasing right-hemispheric shift associated with lower language performance. Thus, normalization of the post-stroke language activation patterns is needed for better language performance while shifts of the activation patterns to the non-dominant (right) hemisphere and/or large stroke size are associated with decreased linguistic abilities after stroke.

An Unusual Case of Poststroke Hallucinations

An Unusual Case of Poststroke Hallucinations

2171 EFFECT OF DOMINANT HEMISPHERIC STROKE ON DETRUSOR FUNCTION IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20112171 EFFECT OF DOMINANT HEMISPHERIC STROKE ON DETRUSOR FUNCTION IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS Tae Gu Kim, Koo Han Yoo, and Seung-kwon Choi Tae Gu KimTae Gu Kim Seoul, Korea, Republic of More articles by this author , Koo Han YooKoo Han Yoo Seoul, Korea, Republic of More articles by this author , and Seung-kwon ChoiSeung-kwon Choi Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2408AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the effect of unilateral hemispheric lesion on voiding dysfunction by comparing urodynamic parameters in dominant, non-dominant and bilateral hemispheric stroke patients. METHODS We retrospectively reviewed the medical records of patients from a magnetic resonance imaging and urodynamic study. We identified 69 cases among 192 stroke patients who had undergone urodynamic study due to lower urinary tract symptoms from June 2003 to December 2008. RESULTS Among the analyzed variables in the urodynamic study, total bladder capacity, voided volume, postvoid residual urine volume, maximum flow rate, average flow rate, detrusor pressure at the maximum flow rate, and bladder compliance did not show statistically significant differences among dominant, non-dominant and bilateral hemispheric stroke patients groups (P > 0.05). The dominant hemispheric stroke group had detrusor overactivity in 64.2% of cases and detrusor underactivity in 35.8%; the non-dominant hemispheric stroke group had detrusor overactivity in 66.7% of cases and detrusor underactivity in 33.3%; and the bilateral stroke group had detrusor overactivity in 60.0% of cases and detrusor underactivity in 40.0% (P = 0.946). CONCLUSIONS Urodynamic findings cannot be characterized by the laterality of the unilateral hemispheric ischemic lesion. There are no significant differences in lower urinary tract symptoms between dominant, non-dominant and bilateral hemispheric ischemic stroke patients. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e870 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tae Gu Kim Seoul, Korea, Republic of More articles by this author Koo Han Yoo Seoul, Korea, Republic of More articles by this author Seung-kwon Choi Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms

To determine the effect of unilateral hemispheric lesion on voiding dysfunction by comparing urodynamic parameters in dominant, non-dominant and bilateral hemispheric stroke patients. We retrospectively reviewed the medical records of patients from a magnetic resonance imaging and urodynamic study. We identified 69 cases among 192 stroke patients who had undergone urodynamic study due to lower urinary tract symptoms from June 2003 to December 2008. Among the analyzed variables in the urodynamic study, total bladder capacity, voided volume, postvoid residual urine volume, maximum flow rate, average flow rate, detrusor pressure at the maximum flow rate, and bladder compliance did not show statistically significant differences among dominant, non-dominant and bilateral hemispheric stroke patients groups (P > 0.05). The dominant hemispheric stroke group had detrusor overactivity in 64.2% of cases and detrusor underactivity in 35.8%; the non-dominant hemispheric stroke group had detrusor overactivity in 66.7% of cases and detrusor underactivity in 33.3%; and the bilateral stroke group had detrusor overactivity in 60.0% of cases and detrusor underactivity in 40.0% (P = 0.946). Urodynamic findings cannot be characterized by the laterality of the unilateral hemispheric ischemic lesion. There are no significant differences in lower urinary tract symptoms between dominant, non-dominant and bilateral hemispheric ischemic stroke patients.

The NIHSS-plus: improving cognitive assessment with the NIHSS.

Background: The National Institutes of Health Stroke Scale (NIHSS) has been criticized for limited representation of cognitive dysfunction and bias towards dominant hemisphere functions. Patients may therefore receive a low NIHSS score despite a fairly large stroke. A broader scale including simple cognitive tests would improve the clinical and research utility of the NIHSS. Methods: We studied 200 patients with acute non-dominant hemispheric stroke who underwent cognitive testing and had MRI with diffusion-weighted imaging (DWI) within 5 days of presentation. We measured DWI volumes and retrospectively calculated NIHSS scores. We used linear regression to determine the role of selected cognitive tests, when added to the NIHSS, in predicting DWI volume. Results: The NIHSS predicted DWI volume in a univariate analysis, as did total line cancellation and a visual perception task. In a multivariate model, using log-transformed variables, the NIHSS (p = 0.0002), line cancellation errors (p = 0.02) and visual perception (p = 0.004) each improved prediction of total infarct volume. Conclusion: The addition of line cancellation and visual perception tasks significantly adds to the model of NIHSS alone in predicting DWI volume. We propose that these two cognitive tests, which together can be completed in 2–3 minutes, could be combined with the NIHSS to create an “NIHSS-plus” that more accurately represents a patient’s ischemic tissue volume after a stroke. This scale requires further validation in a prospective study.

The NIHSS-Plus: Improving Cognitive Assessment with the NIHSS

Background:The National Institutes of Health Stroke Scale (NIHSS) has been criticized for limited representation of cognitive dysfunction and bias towards dominant hemisphere functions. Patients may therefore receive a low NIHSS score despite a fairly large stroke. A broader scale including simple cognitive tests would improve the clinical and research utility of the NIHSS.Methods:We studied 200 patients with acute non-dominant hemispheric stroke who underwent cognitive testing and had MRI with diffusion-weighted imaging (DWI) within 5 days of presentation. We measured DWI volumes and retrospectively calculated NIHSS scores. We used linear regression to determine the role of selected cognitive tests, when added to the NIHSS, in predicting DWI volume.Results:The NIHSS predicted DWI volume in a univariate analysis, as did total line cancellation and a visual perception task. In a multivariate model, using log-transformed variables, the NIHSS (p= 0.0002), line cancellation errors (p= 0.02) and visual perception (p= 0.004) each improved prediction of total infarct volume.Conclusion:The addition of line cancellation and visual perception tasks significantly adds to the model of NIHSS alone in predicting DWI volume. We propose that these two cognitive tests, which together can be completed in 2–3 minutes, could be combined with the NIHSS to create an “NIHSS-plus” that more accurately represents a patient’s ischemic tissue volume after a stroke. This scale requires further validation in a prospective study.

Decompressive craniectomy as a therapeutic option in the treatment of hemispheric stroke

Even though severe hemispheric stroke represents a small subtype of ischemic stroke, the extreme morbidity and mortality necessitate aggressive management strategies to improve outcome. Decompressive craniectomy is an important therapeutic tool with demonstrated effects in significantly reducing intracranial hypertension and mortality from herniation related to cerebral edema and elevated intracranial pressure. Its effect on functional outcome and quality of life varies, but there is evidence to suggest beneficial effects in younger patients and in patients treated earlier. Although more prospective data are required to further identify specific indications for the procedure, it represents an important tool in treatment of nondominant hemispheric stroke.

The neglected role of the right hemisphere in spatial representation of words for reading

Background: Previous studies have indicated that focal brain damage can result in different types of “neglect dyslexia” (reading errors specific to the side of printed material contralateral to the side of brain damage).Aims: To identify the sites of lesions (or dysfunctional brain tissue) responsible for distinct types of neglect dyslexia, to inform a functional neuroanatomical model of brain regions involved in early stages of reading.Methods & Procedures: A battery of tests of hemispatial neglect and reading designed to distinguish neglect dyslexia in different reference frames (viewer-centred, stimulus-centred, and object-centred) was administered to 95 patients within 48 hours of onset of nondominant hemisphere stroke. Magnetic resonance diffusion and perfusion imaging was obtained on the same day as testing. Associations between each type of neglect dyslexia and areas of hypoperfusion and/or infarct were evaluated using chi-squared tests.Outcomes & Results: Viewer-centred neglect dyslexia was associated with hypoperfusion and/or infarct in right angular and supramarginal gyri and visual association cortex (“dorsal stream”). Stimulus-centred neglect dyslexia was associated with hypoperfusion and/or infarct of right superior temporal cortex (“ventral stream”). Object-centred neglect dyslexia was observed only with hypoperfusion and/or infarct of non-dominant superior temporal cortex in left-handed individuals.Conclusions: The identified associations provide evidence that different regions of cortex are critical for spatial attention to, or processing of, representations of words with distinct coordinate frames in the reading task.

Traumatic bilateral carotid dissection with concomitant cerebral infarction

A 40-year-old man presented with a major nondominant hemisphere stroke syndrome after a road traffic accident. Cranial computed tomography scan revealed an extensive right hemisphere infarction involving the entire anterior and middle cerebral artery territories. Duplex Doppler ultrasound and cerebral angiography revealed bilateral internal carotid artery dissection with evidence of underlying fibromuscular dysplasia. Anticoagulation with heparin was commenced despite the coexisting large cerebral infarction, with the objective of protecting the uninjured but at-risk left cerebral hemisphere from ischemic injury. Patients with multiple cerebral arterial dissections complicated by cerebral infarction present a significant management dilemma. Our literature review revealed a lack of clear management guidelines for such cases.

MR perfusion imaging reveals regions of hypoperfusion associated with aphasia and neglect

To evaluate diffusion-weighted imaging (DWI) and MR perfusion imaging (MRPI) as tools for identifying regions of infarct and hypoperfusion associated with aphasia and neglect in hyperacute stroke. Secondary goal: to establish a functional correlate of a radiologically defined "ischemic penumbra." Forty subjects underwent DWI, MRPI, and standardized tests for lexical deficits or hemispatial neglect within 24 hours of stroke onset or progression. Ten patients had repeat DWI, MRPI, and cognitive testing after 3 days (in some cases after reperfusion therapy). Pearson correlations between error rate on cognitive testing and volume of abnormality on DWI versus MRPI were determined at each time period, and regions of hypoperfusion corresponding to specific cognitive deficits were identified. Error rate was more strongly correlated with volume of hypoperfused tissue on MRPI (r = 0.65 to 0.93; p < 0.01 to p < 0.0003) than with volume of lesion on DWI (r = 0.54 to 0.75; p = 0.14 to p < 0.01) for dominant and nondominant hemisphere stroke, at each time point. Forty-eight percent of aphasic patients and 67% of those with hemispatial neglect had either no infarct or only small subcortical infarct on DWI, but had focal cortical hypoperfusion. Patients who had successful reperfusion therapy showed resolution of the hypoperfused territory beyond the infarction on repeat MRPI and showed resolution of corresponding deficits. MRPI shows regions of hypoperfused cortex associated with lexical deficits or hemispatial neglect, even when DWI shows no infarct or only small subcortical infarct. MRPI-DWI mismatch indicates regions of functionally salvageable tissue.

Assessing decisionmaking capacity in a patient with nondominant hemispheric stroke.

Assessing decisionmaking capacity in a patient with nondominant hemispheric stroke.

The Rivermead Perceptual Assessment Battery in Acute Stroke

Eighty-six elderly subjects completed the Rivermead Perceptual Assessment Battery (RPAB) within 14 days of stroke. The RPAB was scored with either a criterion score (number of subtests above cut-off) or total score, calculated by weighting all 16 subtest scores. Three shortened versions of the RPAB were also assessed. The RPAB results were compared with those of line bisection, line cancellation and drawing tests. Perceptual impairment as defined by the RPAB was equally common in dominant and non-dominant hemisphere stroke. RPAB criterion and total scores were correlated with line cancellation, line bisection, limb power and cognitive score. Both RPAB scores were significant univariate predictors of functional outcome and discharge residence. In multivariate models, Barthel ADL score at day 7 and RPAB criterion score were significant predictors of functional outcome; Barthel ADL score at day 7 was the only significant predictor of discharge residence for subjects previously living at home. Total RPAB score was no more useful than criterion score. The shortened RPAB version A predicted outcome as successfully as the full RPAB. The shortened RPAB version A as a screening test of perception following acute stroke is recommended.