The association of visual field deficits and visuo-spatial neglect in acute right-hemisphere stroke patients.
BACKGROUND
Visuo-spatial neglect (VSN) after stroke is associated with a poor prognosis for rehabilitation. The co-existence of a visual field deficit (VFD) with VSN may be associated with impaired visuo-spatial functioning and thereby poor functional outcome.


OBJECTIVE
To determine whether the presence of a VFD (i) exacerbates VSN and (ii) influences recovery of VSN.


METHODS
A prospective study of consecutive acute (<7 days), right-hemisphere stroke patients who were able to undergo detailed assessment of visuo-spatial functioning and visual fields. Clinical assessment and a standardized neuropsychological test was administered by one observer, followed by independent assessment of visual fields by a second observer. Patients were followed up for 12 weeks with 4-weekly re-assessments.


RESULTS
44 consecutive patients (23 women) with a first in a lifetime, acute hemisphere stroke were recruited. Twenty had VSN and VFD, seven VSN only, one VFD only and 17 had normal visual fields and no neglect. The finding of a VFD was significantly associated with the presence of VSN (P<0.0001). Patients with both VFD and VSN had a significantly lower score on the behavioural inattention test. One month post-stroke, this difference was no longer significant. Recovery of VSN and VFD was maximal in the first month, however VSN recovery continued for up to 12 weeks. Patients with VSN and a VFD on admission had a greater mortality at 1 and 3 months.


CONCLUSIONS
The presence of a VFD does appear to exacerbate neglect in the acute stroke patient; this effect is no longer seen after 1 month. Recovery of VSN continues independent of a VFD. Patients with neglect and a VFD have an increased mortality, probably because of greater neurological impairment.
Cassidy
T P
TP
Department of Medicine, Royal Infirmary, Edinburgh, UK.
Bruce
D W
DW
Lewis
S
S
Gray
C S
CS
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000401:mortality / Q000534:rehabilitation; D005260:Female; D006423:Hemianopsia / Q000175:diagnosis* / Q000401:mortality / Q000534:rehabilitation; D006429:Hemiplegia / Q000175:diagnosis* / Q000401:mortality / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009949:Orientation; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D014794:Visual Fields