title: Reperfusion of specific cortical areas is associated with improvement in distinct forms of hemispatial neglect.
abstract: OBJECTIVE
  To test the hypothesis that restoring blood flow to specific right cortical regions in acute stroke results in improvement in distinct forms of hemispatial neglect distinguished by reference frame: viewer-centered versus stimulus-centered neglect.
  
  
  METHODS
  Twenty five patients with acute right stroke were evaluated at Day 1 and Day 3-5 with a battery of neglect tests and Diffusion- and Perfusion-Weighted MR Imaging. Multivariate linear regression analysis revealed Brodmann areas (BAs) where reperfusion predicted degree of improvement in scores on each type of neglect, independently of reperfusion of other areas, total change in the volume of infarct or hypoperfusion, and age.
  
  
  RESULTS
  Reperfusion of dorsal frontoparietal cortex (including BAs 40, 46, and 4) independently predicted improvement in viewer-centered neglect, such as detecting stimuli on left in line cancellation and scene copying (r=.951; p<.0001). Reperfusion of a more ventral temporo-occipital cortex, including right BAs 37, 38, 21 and 18, independently contributed to improvement in stimulus-centered neglect, such as detecting left gaps in circles (r=.926; p<.0001). Reperfusion of right midfusiform gyrus (temporal occipital cortex), change in total volume of ischemia, change in volume of hypoperfusion and age predicted degree of improvement in reading (reduction in "neglect dyslexic" errors; r=.915; p<.0001). Results demonstrate that reperfusing specific cortical regions yields improvement in different types of neglect.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Shaan
authors.initials: S
authors.lastname: Khurshid
authors.forename: Lydia A
authors.initials: LA
authors.lastname: Trupe
authors.forename: Melissa
authors.initials: M
authors.lastname: Newhart
authors.forename: Cameron
authors.initials: C
authors.lastname: Davis
authors.forename: John J
authors.initials: JJ
authors.lastname: Molitoris
authors.forename: Jared
authors.initials: J
authors.lastname: Medina
authors.forename: Richard
authors.initials: R
authors.lastname: Leigh
authors.forename: Argye E
authors.initials: AE
authors.lastname: Hillis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010775:Photic Stimulation; D015424:Reperfusion; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000503:physiopathology