Frequency, risk factors, anatomy, and course of unilateral neglect in an acute stroke cohort.
OBJECTIVE
To delineate the frequency, course, risk factors, and neuroanatomy of hemispatial neglect in a large stroke cohort.


METHODS
One thousand two hundred eighty-one patients with acute stroke were enrolled in a multicenter trial of an anticoagulant. Presence and severity of neglect were assessed with the NIH Stroke Scale (NIHSS) neglect item, assessing tactile extinction and visuospatial neglect at entry, daily for 1 week, and at 3 months. Head CT scans were obtained on day 7, and infarct location and size were characterized.


RESULTS
Neglect was common at presentation, occurring in 43% of right brain-lesioned (RBL) patients and 20% of left brain-lesioned (LBL) patients (p < 0.001). At 3 months, neglect was present in 17% of RBL patients and in 5% of LBL patients (p < 0.001). In RBL patients, neglect was most frequently associated with lesions involving the (in descending order) temporal, parietal, frontal, occipital lobes, basal ganglia, and thalamus. Neglect was more common and persistent with cortical than with subcortical lesions. Increasing age was associated with increased risk of neglect in RBL patients, whereas gender and handedness did not significantly affect neglect frequency.


CONCLUSIONS
This series confirms that hemispatial neglect may occur with damage to several supratentorial structures but is most common and persistent with lesions of the right temporoparietal cortex. Increasing age is associated with neglect, particularly after right brain lesions. Gender and handedness do not exert a marked effect on the likelihood of the occurrence of neglect.
Department of Neurology, University of California, Los Angeles, 710 Westwood Plaza, Suite 2-238, Los Angeles, CA 90095-1769, USA. jringman@mednet.ucla.edu
J M
JM
Ringman
J L
JL
Saver
R F
RF
Woolson
W R
WR
Clarke
H P
HP
Adams
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001479:Basal Ganglia / Q000098:blood supply / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D015331:Cohort Studies; D003871:Dermatan Sulfate / Q000627:therapeutic use; D004292:Dominance, Cerebral; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006497:Heparan Sulfate / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D012307:Risk Factors; D012720:Severity of Illness Index; D013788:Thalamus / Q000098:blood supply / Q000473:pathology
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006497:Heparan Sulfate; C035838:danaparoid