title: Visual neglect after left-hemispheric lesions: a voxel-based lesion-symptom mapping study in 121 acute stroke patients.
abstract: Visual neglect after left-hemispheric lesion is thought to be less frequent, less severe, and shorter lived than visuospatial attention deficits resulting from right-hemispheric lesions. However, reports exist opposing this assumption, and it is unclear how these findings fit into the current theories of visuospatial processing. Furthermore, only little is known about the exact structure-function relationship between visuospatial attention deficits and left-hemispheric stroke. We investigated neglect in 121 patients with acute left-hemispheric ischemic stroke by following clinical development from within the first 24 h of stroke onset until hospital discharge. Visuospatial attention deficits occurred in 17.4 % (n = 21). Voxel-based lesion-symptom mapping associated visual neglect to the right with lesion in the left superior and middle temporal gyrus, temporal pole, frontal operculum, and insula. Neglect severity, captured by the Center of Cancellation Score of the Bells test, was associated with lesion in the left anterior temporal lobe and the left frontal operculum. The left-hemispheric lesion pattern of neglect thus involves areas of the ventral attention system and partly mirrors the critical regions of the right hemisphere known to be associated with neglect. Based on our prospective analysis on a large cohort of patients with left-hemispheric stroke, this study shows that in a remarkable number of patients, the left hemisphere essentially contributes to an intact representation of space and clarifies the impact of the distinct left-hemispheric structures involved in visuospatial processing.
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany. lena.beume@uniklinik-freiburg.de.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany. lena.beume@uniklinik-freiburg.de.|BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany. lena.beume@uniklinik-freiburg.de.
authors.forename: Lena-Alexandra
authors.initials: LA
authors.lastname: Beume
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Martin
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Kaller
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany.|Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Klöppel
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Charlotte S M
authors.initials: CS
authors.lastname: Schmidt
authors.affiliation: Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|Department of Neuroradiology, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.affiliation: Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|Department of Neuroradiology, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Egger
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Rijntjes
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Weiller
authors.affiliation: Department of Neurology and Neuroscience, University Medical Centre Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.|Freiburg Brain Imaging Centre, University Medical Centre Freiburg, 79106, Freiburg, Germany.|BrainLinks-BrainTools Cluster of Excellence, University Medical Centre Freiburg, 79106, Freiburg, Germany.
authors.forename: Roza M
authors.initials: RM
authors.lastname: Umarova
mesh_terms: D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000000981:diagnostic imaging / Q000209:etiology; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D001931:Brain Mapping; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging; D058609:Visual Field Tests; D014796:Visual Perception / Q000502:physiology*
keywords: Hemispheric lateralization; Left hemisphere; Visual neglect; Visuospatial attention system