title: An exploratory cohort study of sensory extinction in acute stroke: prevalence, risk factors, and time course.
abstract: Most studies on sensory extinction have focused on selected patients with subacute and chronic right hemisphere lesions. In studies conducted on acute stroke patients, risk factors and time course were not evaluated. Our aim was to determine the prevalence, risk factors, and time course of sensory extinction in the acute stroke setting. Consecutive patients with acute stroke were tested for tactile, visual, auditory, and auditory-tactile cross-modal extinction, as well as for peripersonal visuospatial neglect (PVN). Tests were repeated at 2, 7, 15, 30, and 90 days after initial examination. A multivariable logistic regression analysis was performed to test the association between sensory extinction and demographic and clinical risk factors. Seventy-three patients (38.4% women) were recruited: 64 with ischemic stroke and nine with haemorrhagic stroke. Mean age was 62.3 years (95% CI 58.8-65.7), mean NIHSS score was 1.6 (95% CI 1.2-2.1), and mean time to first examination was 4.1 days (95% CI 3.5-4.8). The overall prevalence of all subtypes of sensory extinction was 13.7% (95% CI 6.8-23.8). Tactile extinction was the most frequent subtype with a prevalence of 8.2% (95% CI 3.1-17.0). No extinction was found beyond 15 days after the first examination. After adjustment for age, sex, lesion side, type of stroke, time to first examination and stroke severity, a lesion volume ≥2 mL (adjusted OR = 38.88, p = 0.04), and presence of PVN (adjusted OR = 24.27, p = 0.04) were independent predictors of sensory extinction. The insula, the putamen, and the pallidum were the brain regions most frequently involved in patients with sensory extinction. Extinction is a rare and transient phenomenon in patients with minor stroke. The presence of PVN and lesion volume ≥2 mL are independent predictors of sensory extinction in acute stroke.
authors.affiliation: Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland. tatuene@liv.ac.uk.|Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE, UK. tatuene@liv.ac.uk.
authors.forename: Joseph
authors.identifier: 0000-0002-1041-4202
authors.initials: J
authors.lastname: Kamtchum-Tatuene
authors.affiliation: Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.|Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
authors.forename: Gilles
authors.initials: G
authors.lastname: Allali
authors.affiliation: Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.|Neurology and Cognitive Imaging Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Saj
authors.affiliation: Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Bernati
authors.affiliation: Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Sztajzel
authors.affiliation: Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
authors.affiliation: Neurology and Neurophysiology Centre, Geneva, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Momjian-Mayor
authors.affiliation: Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kleinschmidt
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012678:Sensation Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors
keywords: Acute stroke; Prognosis; Risk factors; Sensory extinction; Visuospatial neglect